Provider Demographics
NPI:1083491351
Name:KELLOUGH, DREW STEVEN (LICSW)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:STEVEN
Last Name:KELLOUGH
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-2922
Mailing Address - Country:US
Mailing Address - Phone:205-789-0459
Mailing Address - Fax:
Practice Address - Street 1:702 N NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-2922
Practice Address - Country:US
Practice Address - Phone:205-789-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5388C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical