Provider Demographics
NPI:1427226497
Name:KELLY, TERESA GAYLE (LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:GAYLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 EXETER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3945
Mailing Address - Country:US
Mailing Address - Phone:901-626-7111
Mailing Address - Fax:901-755-6152
Practice Address - Street 1:2022 EXETER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3945
Practice Address - Country:US
Practice Address - Phone:901-626-7111
Practice Address - Fax:901-755-6152
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2276101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional