MEDICARE: MISS KELLY MORGAN MCCRADIC MA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178018117	IL
2	251S00000X	Community/Behavioral Health Agency	178018117	IL

General Provider Information

NPI Number	:	1124774732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELLY MORGAN MCCRADIC MA LPC

Provider Business Mailing Address
First Line	:	2443 N KILDARE AVE APT 3F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2079
Country	:	US
Telephone Number	:	224-388-2846
Fax Number	:

Provider Business Practice Location Address
First Line	:	2443 N KILDARE AVE APT 3F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2079
Country	:	US
Telephone Number	:	224-388-2846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	04/17/2026

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