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General NPI Number Information
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NPI Number | 1942666318
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Entity Type | Individual
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Provider Name | CHRISTIE LYNN KELLY T-LPC
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Gender | Female
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 809 S PATTON RD
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City | GREAT BEND
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State | KS
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Zip | 67530-4620
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Country | US
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Telephone | 620-796-2206
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Fax | 866-288-1782
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Provider Business Mailing Address
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Address Line | PO BOX 1223
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City | GREAT BEND
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State | KS
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Zip | 67530-1223
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Country | US
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Telephone | 620-796-2206
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Fax | 866-288-1782
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 703
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2755
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License Number State | KS
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