Individual
KELLY HOLDER-COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LICDC
Contact information
Practice address
206 E MARKET ST, LIMA, OH 45801-4914
(937) 387-6395
Mailing address
535 E 4TH ST, DELPHOS, OH 45833-1504
(419) 979-8944
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
121121
OH
101YP2500X
Professional Counselor
Primary
C.1300431
OH
Other
Enumeration date
04/24/2017
Last updated
09/29/2021
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