Healthcare Provider Details

I. General information

NPI: 1306737325
Provider Name (Legal Business Name): ALEXIS SIERRA LYNN KELLY MS, LPC/MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS SIERRA LYNN TERRELL

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR STE 201
MEMPHIS TN
38125-8913
US

IV. Provider business mailing address

815 PECAN GARDENS CIR E
MEMPHIS TN
38122-2519
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-5066
  • Fax: 719-623-0165
Mailing address:
  • Phone: 423-534-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7687
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: