Provider Demographics
NPI:1871068783
Name:MORA, KELSEY LYNN (CCLS, LCPC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:MORA
Suffix:
Gender:F
Credentials:CCLS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTRAL AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3024
Mailing Address - Country:US
Mailing Address - Phone:847-231-2021
Mailing Address - Fax:
Practice Address - Street 1:400 CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3024
Practice Address - Country:US
Practice Address - Phone:402-650-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21412174400000X
IL180.014683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist