Provider Demographics
NPI:1275877920
Name:KELLEY, JARRED (LPCC)
Entity Type:Individual
Prefix:
First Name:JARRED
Middle Name:
Last Name:KELLEY
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7757
Mailing Address - Country:US
Mailing Address - Phone:270-926-2484
Mailing Address - Fax:270-685-6011
Practice Address - Street 1:300 HOPE ST
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7757
Practice Address - Country:US
Practice Address - Phone:270-926-2484
Practice Address - Fax:270-685-6011
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health