Provider Demographics
NPI:1609960376
Name:KELLUM, KIMBERLY A (MS/LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:KELLUM
Suffix:
Gender:F
Credentials:MS/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:BURLISON
Mailing Address - State:TN
Mailing Address - Zip Code:38015-0170
Mailing Address - Country:US
Mailing Address - Phone:019-586-6317
Mailing Address - Fax:
Practice Address - Street 1:3865 BEAVER RD
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058-4277
Practice Address - Country:US
Practice Address - Phone:901-586-6317
Practice Address - Fax:901-296-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0802017101YP2500X
TN4022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional