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Individual
MARY TERESA KELLY
Active
Individual
MARY TERESA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
NLC.0010159
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NLC.0010159
STATE REGISTRATION NUMBER
CO
Enumeration date
01/05/2018
Last updated
01/05/2018
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