Provider Demographics
NPI:1366626913
Name:JONES, KELLIE S (MA, LPP)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:S
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 HIDDEN AWAY LN
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-8798
Mailing Address - Country:US
Mailing Address - Phone:859-351-8746
Mailing Address - Fax:859-873-0966
Practice Address - Street 1:1450 N BROADWAY STE 312
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3162
Practice Address - Country:US
Practice Address - Phone:859-351-8746
Practice Address - Fax:859-873-0966
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY115833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical