Provider Demographics
NPI:1447707054
Name:ARMSTRONG, KELLY A (LPCC E2001681)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:ARMSTRONG
Suffix:
Gender:F
Credentials:LPCC E2001681
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9541 OLDE POND LN
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-1679
Mailing Address - Country:US
Mailing Address - Phone:216-245-7314
Mailing Address - Fax:
Practice Address - Street 1:8500 STATION ST STE 102
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4968
Practice Address - Country:US
Practice Address - Phone:216-457-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400597101YP2500X
OHE.2001681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid
OHC.1400597OtherOHIO LICENSE #
OH2871101Medicaid