Individual
DR. THERESA ANN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
100 NORTH 43RD STREET, HERRIN, IL 62948
(618) 364-4415
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-006782
IL
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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