Individual
MR. TIMOTHY PATRICK KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3900 WOODLAND AVE, PHILADELPHIA, PA 19104-4551
(215) 823-5800
(215) 823-5919
Mailing address
2340 HIGH RD, HUNTINGDON VALLEY, PA 19006-6512
(215) 823-5800
(215) 823-5919
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PC001954
PA
101YA0400X
Addiction (Substance Use Disorder) Counselor
PC001954
PA
101YM0800X
Mental Health Counselor
PC001954
PA
101YP1600X
Pastoral Counselor
Primary
PC001954
PA
101YP2500X
Professional Counselor
PC001954
PA
103T00000X
Psychologist
01360
OK
Other
Enumeration date
09/15/2006
Last updated
02/28/2008
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