Provider Demographics
NPI:1730582453
Name:INGLESON, KELLY SCOLNICK (LPC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SCOLNICK
Last Name:INGLESON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10035 E MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8853
Mailing Address - Country:US
Mailing Address - Phone:231-590-3167
Mailing Address - Fax:231-242-1659
Practice Address - Street 1:10035 E MITCHELL RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8853
Practice Address - Country:US
Practice Address - Phone:231-590-3167
Practice Address - Fax:231-242-1659
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional