MEDICARE: KELLY ANNE GILLETTE LPC/MHSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	5591	TN
2	101YP2500X	Professional Counselor	5591	TN

General Provider Information

NPI Number	:	1306515630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANNE GILLETTE LPC/MHSP

Provider Business Mailing Address
First Line	:	3122 ORCHARD AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-2943
Country	:	US
Telephone Number	:	248-342-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 CENTER PARK DR STE 1300
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2124
Country	:	US
Telephone Number	:	248-342-3203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

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