Individual
TIMOTHY J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LCPC
Contact information
Practice address
9400 LEBANON RD, EAST SAINT LOUIS, IL 62203-2214
(618) 397-0968
Mailing address
9400 LEBANON RD, EAST SAINT LOUIS, IL 62203-2214
(618) 397-0968
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180013984
IL
101YP2500X
Professional Counselor
180013984
IL
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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