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General NPI Number Information
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NPI Number | 1477099828
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Entity Type | Individual
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Provider Name | KELLEY RIEDER KLUNGLAND LPC-MHSP
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Gender | Female
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 1401 WILLIAMS ST STE 210
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City | CHATTANOOGA
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State | TN
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Zip | 37408-1190
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Country | US
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Telephone | 423-207-4712
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 CHESTNUT ST APT 241
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City | CHATTANOOGA
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State | TN
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Zip | 37402-4521
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Country | US
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Telephone | 931-247-0608
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5357
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License Number State | TN
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