Healthcare Provider Details

I. General information

NPI: 1538501283
Provider Name (Legal Business Name): KELLI KRISTINE MCCLOY L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

104 CLOVERDALE CT
HENDERSONVILLE TN
37075-2907
US

V. Phone/Fax

Practice location:
  • Phone: 615-332-1109
  • Fax:
Mailing address:
  • Phone: 615-332-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090892
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: