Provider Demographics
NPI:1962559492
Name:GULLEY, LEONA GRACE (LPC, RN,CS)
Entity type:Individual
Prefix:DR
First Name:LEONA
Middle Name:GRACE
Last Name:GULLEY
Suffix:
Gender:F
Credentials:LPC, RN,CS
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 192
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-0192
Mailing Address - Country:US
Mailing Address - Phone:423-472-5652
Mailing Address - Fax:
Practice Address - Street 1:11014 APISON PIKE
Practice Address - Street 2:
Practice Address - City:APISON
Practice Address - State:TN
Practice Address - Zip Code:37302-9768
Practice Address - Country:US
Practice Address - Phone:423-236-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3156862Medicare UPIN