Doctor Name: | MS. KELLY LYNNE CANAVAN |
NPI Number: | 1003221045 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180.009124 |
Business Practice Address: | 800 S Mchenry Ave Crystal Lake, IL - 600147487 |
Business Phone Number: | 8159792580 |
Business Fax Number: | |
Mailing Address: | 800 S Mchenry Ave, CRYSTAL LAKE |
State: | IL |
Postal Code: | 600147487 |
Phone Number: | 8159792580 |
Fax Number: | |
NPI Enumeration Date: | 06/28/2014 |
NPI Last Update Date: | 06/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 180.009124 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |