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General NPI Number Information
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NPI Number | 1306515630
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Entity Type | Individual
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Provider Name | KELLY ANNE GILLETTE LPC/MHSP
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Gender | Female
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 111 CENTER PARK DR STE 1300
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City | KNOXVILLE
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State | TN
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Zip | 37922-2124
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Country | US
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Telephone | 248-342-3203
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Fax |
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Provider Business Mailing Address
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Address Line | 3122 ORCHARD AVE
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City | KNOXVILLE
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State | TN
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Zip | 37917-2943
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Country | US
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Telephone | 248-342-3203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5591
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5591
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License Number State | TN
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