Individual
KRISTEN GIDEL KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC, LICDC, CTTS
Contact information
Practice address
384 STREAMWATER DR, BLACKLICK, OH 43004-8132
(419) 344-9079
Mailing address
384 STREAMWATER DR, BLACKLICK, OH 43004-8132
(419) 344-9079
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
E.1110035
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
757
DEPARTMENT OF VETERANS AFFAIRS
OH
Enumeration date
07/31/2016
Last updated
07/31/2016
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