Individual
THERESA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.,LPC,LCPC
Contact information
Practice address
4919 W CATALPA AVE, CHICAGO, IL 60630-1514
(773) 562-6230
Mailing address
4919 W CATALPA AVE, CHICAGO, IL 60630-1514
(773) 562-6230
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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