Individual
MOLLYROSE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LCPC
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
180.012855
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178.012734
ILLINOIS DEPARTMENT OF PUBLIC HEALTH
IL
01
—
180.012855
LICENSE
IL
Enumeration date
09/05/2018
Last updated
05/04/2020
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