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General NPI Number Information
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NPI Number | 1437342425
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Entity Type | Individual
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Provider Name | KELLY JO HART MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 3149 OLD CLARKSVILLE SPGFLD RD
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City | ADAMS
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State | TN
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Zip | 37010-8908
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Country | US
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Telephone | 910-644-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 3149 OLD CLARKSVILLE SPGFLD RD
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City | ADAMS
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State | TN
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Zip | 37010-8908
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Country | US
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Telephone | 910-644-2410
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6609
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 19353
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13233
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License Number State | NC
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