| Doctor Name: | MRS. KELLY MARIE PACK |
| NPI Number: | 1972725448 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LISW-S |
| License Number: | I0007769 |
| Business Practice Address: | 270 Sterkel Blvd Mansfield, OH - 449071508 |
| Business Phone Number: | 4197561133 |
| Business Fax Number: | |
| Mailing Address: | 6815 County Road 37, Po Box 9166 LEXINGTON |
| State: | OH |
| Postal Code: | 449049694 |
| Phone Number: | 4193621597 |
| Fax Number: | |
| NPI Enumeration Date: | 05/03/2007 |
| NPI Last Update Date: | 03/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | I0007769 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |