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General NPI Number Information
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NPI Number | 1821722059
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Entity Type | Individual
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Provider Name | WILLIAM KELLY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 2010 W CHESTER PIKE STE 314
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City | HAVERTOWN
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State | PA
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Zip | 19083-2737
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Country | US
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Telephone | 412-736-6551
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Fax |
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Provider Business Mailing Address
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Address Line | 6617 S HALF MOON DR APT B
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City | BAKERSFIELD
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State | CA
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Zip | 93309-7876
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Country | US
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Telephone | 412-736-6551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC009311
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License Number State | PA
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