Provider Demographics
NPI:1245788009
Name:ELLER, KATHRYN ELIZABETH (LPCMHSP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:ELLER
Suffix:
Gender:F
Credentials:LPCMHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N HOLTZCLAW AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1236
Mailing Address - Country:US
Mailing Address - Phone:423-209-7091
Mailing Address - Fax:423-209-7088
Practice Address - Street 1:801 N HOLTZCLAW AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1236
Practice Address - Country:US
Practice Address - Phone:423-209-7091
Practice Address - Fax:423-209-7088
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3715101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)