Most Relevant Information
Provider Data
| NPI Number: | 1003293838 |
| Provider Name: | SANDRA DEMOS KELLEY LCPC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 1800004640 |
Most Important Dates
| Enumeration Date: | 04/30/2015 |
| Last Updated: | 04/30/2015 |
Provider Practice Location
8300 BROADWAY
F1
MERRILLVILLE
IN
464108602
Practice Location Phone/Fax
| Phone: | 2197361000 |
| Fax: | 2197369699 |
Provider Mailing Location
8300 BROADWAY
F1
MERRILLVILLE
IN
464108602
Provider Mailing Phone/Fax
| Phone: | 2197361000 |
| Fax: | 2197369699 |