Provider Demographics
NPI:1215903109
Name:KELLEY, WENDELL AARON (LPC)
Entity type:Individual
Prefix:
First Name:WENDELL
Middle Name:AARON
Last Name:KELLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 METROPLEX DR
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3139
Mailing Address - Country:US
Mailing Address - Phone:615-781-0013
Mailing Address - Fax:615-781-0688
Practice Address - Street 1:446 METROPLEX DR
Practice Address - Street 2:SUITE A-100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3139
Practice Address - Country:US
Practice Address - Phone:615-781-0013
Practice Address - Fax:615-781-0688
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 1923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional