Provider Demographics
NPI:1831165885
Name:HAUGHT, KELLY SHAUN (LPC)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:SHAUN
Last Name:HAUGHT
Suffix:
Gender:F
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:PO BOX 4475
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-4475
Mailing Address - Country:US
Mailing Address - Phone:423-292-8364
Mailing Address - Fax:423-434-2991
Practice Address - Street 1:207 E MAIN ST
Practice Address - Street 2:FOUNTAIN PLACE SUITE 1C
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5747
Practice Address - Country:US
Practice Address - Phone:423-292-4673
Practice Address - Fax:423-434-2991
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1498101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional