Provider Demographics
NPI:1528802030
Name:HALL, KELLY JEANINE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEANINE
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HAZEL PATH STE 2
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3817
Mailing Address - Country:US
Mailing Address - Phone:615-948-5488
Mailing Address - Fax:
Practice Address - Street 1:115 HAZEL PATH STE 2
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3817
Practice Address - Country:US
Practice Address - Phone:615-948-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional