Provider Demographics
NPI:1366227092
Name:KELLY STREIT, LGPC
Entity type:Organization
Organization Name:KELLY STREIT, LGPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STREIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-920-4315
Mailing Address - Street 1:6205 SANDPIPER CT APT 208
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5394
Mailing Address - Country:US
Mailing Address - Phone:443-920-4315
Mailing Address - Fax:
Practice Address - Street 1:6205 SANDPIPER CT APT 208
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5394
Practice Address - Country:US
Practice Address - Phone:443-920-4315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty