Healthcare Provider Details

I. General information

NPI: 1275877920
Provider Name (Legal Business Name): JARRED KELLEY LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOPE ST
MOUNT WASHINGTON KY
40047-7757
US

IV. Provider business mailing address

300 HOPE ST
MOUNT WASHINGTON KY
40047-7757
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2484
  • Fax: 270-685-6011
Mailing address:
  • Phone: 270-926-2484
  • Fax: 270-685-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: