| Kelly's Grief Center | |
|
135 E Erie St Ste 302 Kent OH 44240-3594 | |
| (330) 593-5959 | |
| Not Available |
| Full Name | Kelly's Grief Center |
|---|---|
| Speciality | Counselor |
| Location | 135 E Erie St Ste 302, Kent, Ohio |
| Authorized Official Name and Position | Phyllis a Vair (COUNSELOR) |
| Authorized Official Contact | 3305935959 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly's Grief Center 135 E Erie St Ste 302 Kent OH 44240-3594 Ph: (330) 593-5959 | Kelly's Grief Center 135 E Erie St Ste 302 Kent OH 44240-3594 Ph: (330) 593-5959 |
| NPI Number | 1295220986 |
|---|---|
| Provider Enumeration Date | 06/26/2018 |
| Last Update Date | 02/14/2020 |
| Certification Date | 02/14/2020 |
| Medicare PECOS PAC ID | 2961885314 |
|---|---|
| Medicare Enrollment ID | O20220817001683 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295220986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (NU) | Primary |
| Provider Name | Dina M Douglas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023500691 PECOS PAC ID: 0042554685 Enrollment ID: I20181207001496 |
| Provider Name | Christina R Dawson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922658202 PECOS PAC ID: 3779813910 Enrollment ID: I20191001001902 |
| Provider Name | Shannon Rae Speaks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073122313 PECOS PAC ID: 8224437421 Enrollment ID: I20210520000288 |
| Provider Name | Christie Rush |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871096008 PECOS PAC ID: 8426404286 Enrollment ID: I20231031000377 |
| Provider Name | Phyllis Ann Vair |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073031373 PECOS PAC ID: 1153769955 Enrollment ID: I20240328003703 |
| Provider Name | Alexandra Sommer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487221529 PECOS PAC ID: 7315488541 Enrollment ID: I20240916001645 |
| Provider Name | Emma Carleton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811689045 PECOS PAC ID: 7911346283 Enrollment ID: I20251230000999 |
| Provider Name | Lindsey Conway |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619465556 PECOS PAC ID: 7618457300 Enrollment ID: I20260212001963 |
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