Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Kelly Wallace

Individual provider Mental Health Counselor · NPI 1427726793

Mr. Kelly Wallace is a Mental Health Counselor in Philadelphia, Pennsylvania. Practices as a sole proprietor. Registered with an NPI since 2021.

In the registry since
2021

Practice location Address checks out

1348 Bainbridge St
Philadelphia, PA 19147-1810
Phone: (215) 563-0652
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1427726793
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 1, 2021
Last updated in NPPESSeptember 1, 2021
Certification dateAugust 11, 2021

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