Provider Demographics
NPI:1700612413
Name:FRAZEY, KELLY (LPC-A)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FRAZEY
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 PUBLIC SQ STE 105
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7864
Mailing Address - Country:US
Mailing Address - Phone:623-696-7757
Mailing Address - Fax:
Practice Address - Street 1:36 PUBLIC SQ STE 105
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7864
Practice Address - Country:US
Practice Address - Phone:623-696-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2406480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health