Provider Demographics
NPI:1497025159
Name:GOLDEN, KELLY MCKENNEY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MCKENNEY
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:NICHOLE
Other - Last Name:MCKENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1563 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-324-1060
Mailing Address - Fax:508-679-8590
Practice Address - Street 1:1563 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-324-1060
Practice Address - Fax:508-679-8590
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health