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General NPI Number Information
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NPI Number | 1912452988
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Entity Type | Individual
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Provider Name | LAURA KELLY LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 6258 N ARTESIAN AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60659-2845
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Country | US
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Telephone | 847-340-5809
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Fax |
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Provider Business Mailing Address
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Address Line | 3653 W LELAND AVE APT 3W
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City | CHICAGO
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State | IL
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Zip | 60625-6434
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Country | US
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Telephone | 847-340-5809
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 178010926
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.012160
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License Number State | IL
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