Provider Demographics
NPI:1467665950
Name:COTHRAN, KELLY M (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:M
Last Name:COTHRAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2409 HOMER CLAYTON DR.
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2207
Mailing Address - Country:US
Mailing Address - Phone:256-582-4240
Mailing Address - Fax:256-582-4161
Practice Address - Street 1:2409 HOMER CLAYTON DR.
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2207
Practice Address - Country:US
Practice Address - Phone:256-582-4240
Practice Address - Fax:256-582-4161
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health