Healthcare Provider Details

I. General information

NPI: 1780254417
Provider Name (Legal Business Name): KELLY ELIZABETH SHEETS LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ELIZABETH BROWN

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61594 ELDERBERRY LN
SOUTH BEND IN
46614-5810
US

IV. Provider business mailing address

842 LAMONT ST
KINGSPORT TN
37664-3009
US

V. Phone/Fax

Practice location:
  • Phone: 276-469-5134
  • Fax:
Mailing address:
  • Phone: 276-469-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016867
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5475
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224045
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39006050A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: