Provider Demographics
NPI:1801773593
Name:KELLY, KENDALL L (LAPC)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:L
Last Name:KELLY
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 LYNDA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-1819
Mailing Address - Country:US
Mailing Address - Phone:412-935-1874
Mailing Address - Fax:
Practice Address - Street 1:3025 JACKS RUN RD
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2549
Practice Address - Country:US
Practice Address - Phone:412-537-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALAPC1537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health