Provider Demographics
NPI:1427297761
Name:HOOD, KELLI DAWN (LPCC)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:DAWN
Last Name:HOOD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-7791
Mailing Address - Country:US
Mailing Address - Phone:314-540-3042
Mailing Address - Fax:502-633-4043
Practice Address - Street 1:213 MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-7791
Practice Address - Country:US
Practice Address - Phone:502-647-0154
Practice Address - Fax:502-633-4043
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165650101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100439290Medicaid