Provider Demographics
NPI:1609684034
Name:HAUGHEY, KELLY L (LPC, NCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:HAUGHEY
Suffix:
Gender:
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 E BALTIMORE PIKE STE 300
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5173
Mailing Address - Country:US
Mailing Address - Phone:610-892-3800
Mailing Address - Fax:
Practice Address - Street 1:1055 E BALTIMORE PIKE STE 300
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5173
Practice Address - Country:US
Practice Address - Phone:610-892-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016220101YP2500X
MDPC016220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional