Provider Demographics
NPI:1699443374
Name:HOLLEY, KELLY (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2021 RICHARD JONES RD STE 350B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2871
Mailing Address - Country:US
Mailing Address - Phone:615-241-5648
Mailing Address - Fax:
Practice Address - Street 1:2021 RICHARD JONES RD STE 350B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2871
Practice Address - Country:US
Practice Address - Phone:615-241-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health