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General NPI Number Information
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NPI Number | 1659569192
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Entity Type | Individual
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Provider Name | SUZANNE P KELLEY LPC/MHSP, NCC
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Gender | Female
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 101 JORDAN DR
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6732
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Country | US
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Telephone | 423-509-3829
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Fax |
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Provider Business Mailing Address
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Address Line | 13574 BRAXTON LN
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City | BIRCHWOOD
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State | TN
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Zip | 37308-5089
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Country | US
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Telephone | 423-443-1312
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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 | 2659
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License Number State | TN
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