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NPI Code Detail

MEDICARE: MRS. KELLY J VEAL LPC

MEDICARE: MRS. KELLY J VEAL 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
1101YA0400XAddiction (Substance Use Disorder) CounselorLPC006806GA
2101YP2500XProfessional CounselorLPC006806GA

General Provider Information

NPI Number : 1720417140
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY J VEAL LPC
Provider Business Mailing Address
First Line : 416 PARK AVE
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-3034
Country : US
Telephone Number : 706-594-8148
Fax Number : 706-884-5056
Provider Business Practice Location Address
First Line : 610 RIDLEY AVE
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2236
Country : US
Telephone Number : 706-594-8148
Fax Number : 706-884-5056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2013
Last Update Date : 11/06/2013

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