Healthcare Provider Details

I. General information

NPI: 1023846292
Provider Name (Legal Business Name): BARBRA CIERRA KELLEY MMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W MAIN ST
LEBANON TN
37087-3402
US

IV. Provider business mailing address

2219 HIGH MEADOW DR
MURFREESBORO TN
37129-4030
US

V. Phone/Fax

Practice location:
  • Phone: 615-784-9209
  • Fax:
Mailing address:
  • Phone: 615-969-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: