MEDICARE: MR. DANNY KELLUM 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	101YP2500X	Professional Counselor	LPC0000001652	TN
2	101YP2500X	Professional Counselor	0701003303	VA

General Provider Information

NPI Number	:	1346415254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANNY KELLUM LPC

Provider Business Mailing Address
First Line	:	PO BOX 4721
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37602-4721
Country	:	US
Telephone Number	:	423-967-9208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 E OAKLAND AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1844
Country	:	US
Telephone Number	:	423-967-9208
Fax Number	:

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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Directions to “ MR. DANNY KELLUM LPC” Practice Location

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