Provider Demographics
NPI:1437252848
Name:KANEY, WESLEY STUART (LCSW)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:STUART
Last Name:KANEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 PARKER LN
Mailing Address - Street 2:
Mailing Address - City:BRADYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37026-5343
Mailing Address - Country:US
Mailing Address - Phone:615-765-5751
Mailing Address - Fax:
Practice Address - Street 1:6110 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1615
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:866-341-7509
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000011041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3698934Medicaid
TN3698934Medicaid