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Individual
THERESA KELLY
Active
Individual
THERESA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.,LPC,LCPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
178006846
IL
101Y00000X
Counselor
Primary
180009878
IL
Other
Enumeration date
09/16/2015
Last updated
03/30/2021
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