Provider Demographics
NPI:1154013449
Name:KELLIE R DRYDEN LCSW COUNSELING SERVICES
Entity type:Organization
Organization Name:KELLIE R DRYDEN LCSW COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:REAGAN
Authorized Official - Last Name:DRYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-806-9455
Mailing Address - Street 1:424 LEWIS HARGETT CIR STE 250
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3687
Mailing Address - Country:US
Mailing Address - Phone:859-806-9455
Mailing Address - Fax:
Practice Address - Street 1:424 LEWIS HARGETT CIR STE 250
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3687
Practice Address - Country:US
Practice Address - Phone:859-806-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty