MEDICARE: KELLY ELIZABETH SHEETS LPC-MHSP

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	180016867	IL
2	101YP2500X	Professional Counselor	5475	TN
3	101YP2500X	Professional Counselor	6401224045	MI
4	101YM0800X	Mental Health Counselor	39006050A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5475	OTHER	TN	TN DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1780254417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ELIZABETH SHEETS LPC-MHSP

Provider Business Mailing Address
First Line	:	842 LAMONT ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3009
Country	:	US
Telephone Number	:	276-469-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	61594 ELDERBERRY LN
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-5810
Country	:	US
Telephone Number	:	276-469-5134
Fax Number	:

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

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	05/26/2026

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