| Doctor Name: | SANDRA DEMOS KELLEY |
| NPI Number: | 1003293838 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | 1800004640 |
| Business Practice Address: | 8300 Broadway F1 Merrillville, IN - 464108602 |
| Business Phone Number: | 2197361000 |
| Business Fax Number: | 2197369699 |
| Mailing Address: | 8300 Broadway, F1 MERRILLVILLE |
| State: | IN |
| Postal Code: | 464108602 |
| Phone Number: | 2197361000 |
| Fax Number: | 2197369699 |
| NPI Enumeration Date: | 04/30/2015 |
| NPI Last Update Date: | 04/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1800004640 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |