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Individual

MATTHEW KELLOUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PRS

Contact information

Practice address
551 E MAIN ST, LANCASTER, OH 43130-3809
(614) 404-6008
Mailing address
PO BOX 243, SUGAR GROVE, OH 43155-0243
(614) 404-6008

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
175T00000X
Peer Specialist
Primary
APS.003590
OH

Other

Enumeration date
10/12/2022
Last updated
10/13/2022
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