Provider Demographics
NPI:1871210302
Name:MYERS, KELLY ELAINE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELAINE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 OZELLA LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6222
Mailing Address - Country:US
Mailing Address - Phone:865-363-4189
Mailing Address - Fax:
Practice Address - Street 1:192 OZELLA LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6222
Practice Address - Country:US
Practice Address - Phone:865-363-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional