MEDICARE: KELLY H HARVEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	407	NH
2	101YM0800X	Mental Health Counselor	007390	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12119524	OTHER	NH	CAQH APPLICATION #

General Provider Information

NPI Number	:	1306088539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY H HARVEY LPC

Provider Business Mailing Address
First Line	:	6595 ROSWELL RD # G6308
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	404-599-7015
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 ROSWELL RD # G6308
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	404-599-7015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	08/05/2021

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Directions to “ KELLY H HARVEY LPC” Practice Location

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