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NPI Code Detail

MEDICARE: KELLI T CENTER LPC

MEDICARE: KELLI T CENTER 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
1101YM0800XMental Health CounselorLPC-15353AZ
2101YP2500XProfessional CounselorLPC-15353AZ

General Provider Information

NPI Number : 1821488222
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI T CENTER LPC
Provider Business Mailing Address
First Line : 3355 LENOX RD NE STE 1000
Second Line :
City : ATLANTA
State : GA
Zip : 30326-2000
Country : US
Telephone Number : 602-809-0816
Fax Number : 855-436-5564
Provider Business Practice Location Address
First Line : 3355 LENOX RD NE STE 1000
Second Line :
City : ATLANTA
State : GA
Zip : 30326-2000
Country : US
Telephone Number : 800-204-4195
Fax Number : 855-436-5564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2015
Last Update Date : 10/20/2020

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Directions to “ KELLI T CENTER LPC” Practice Location

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