Most Relevant Information
Provider Data
| NPI Number: | 1003221045 |
| Provider Name: | KELLY LYNNE CANAVAN LCPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 180.009124 |
Most Important Dates
| Enumeration Date: | 06/28/2014 |
| Last Updated: | 08/17/2023 |
Provider Practice Location
650 E TERRA COTTA AVENUE
UNIT 103
CRYSTAL LAKE
IL
600143654
Practice Location Phone/Fax
| Phone: | 8159792580 |
| Fax: | 8153543517 |
Provider Mailing Location
650 E TERRA COTTA AVENUE
UNIT 103
CRYSTAL LAKE
IL
600143654
Provider Mailing Phone/Fax
| Phone: | 8159792580 |
| Fax: | 8153543517 |