Individual
JASHAWN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1145 ARROTT ST FL 2F, PHILADELPHIA, PA 19124-3167
(267) 994-2624
(855) 489-7959
Mailing address
1145 ARROTT ST FL 2F, PHILADELPHIA, PA 19124-3167
(267) 209-0584
(855) 489-7959
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PC011754
PA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/08/2018
Last updated
08/03/2020
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