MEDICARE: CHRISTINA KELLEY 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	101YP2500X	Professional Counselor	LPC-10924	AZ
2	101YM0800X	Mental Health Counselor	LPC.0022517	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598308835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA KELLEY LPC

Provider Business Mailing Address
First Line	:	4539 N 22ND ST # 4222
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	623-624-9568
Fax Number	:

Provider Business Practice Location Address
First Line	:	4539 N 22ND ST # 4222
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4639
Country	:	US
Telephone Number	:	623-624-9568
Fax Number	:

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

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	04/27/2026

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Directions to “ CHRISTINA KELLEY LPC” Practice Location

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