Provider Demographics
NPI:1073864039
Name:PERREL, KELLY (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:
Last Name:PERREL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SHADY DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2980
Mailing Address - Country:US
Mailing Address - Phone:423-315-2328
Mailing Address - Fax:
Practice Address - Street 1:3917 VOLUNTEER DR STE 121
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-3885
Practice Address - Country:US
Practice Address - Phone:423-541-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-30
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TNLSW00000068781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker