Provider Demographics
NPI:1053958900
Name:GAVRAN, KELLIE JO (LPC)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:JO
Last Name:GAVRAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EDMUND AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4630
Mailing Address - Country:US
Mailing Address - Phone:724-970-3252
Mailing Address - Fax:
Practice Address - Street 1:150 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2354
Practice Address - Country:US
Practice Address - Phone:724-970-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000510101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional