Provider Demographics
NPI:1043391980
Name:TILLEY, KELLY RENEE (MA, LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:RENEE
Last Name:TILLEY
Suffix:
Gender:F
Credentials:MA, LPCC-S
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RENEE
Other - Last Name:CLAPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:39066 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44253-9603
Mailing Address - Country:US
Mailing Address - Phone:440-376-1842
Mailing Address - Fax:
Practice Address - Street 1:625 LOOP RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44242-9225
Practice Address - Country:US
Practice Address - Phone:330-672-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3996101YP2500X
OHE.0003996-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional