Provider Demographics
NPI:1629238548
Name:MILLS, KELLY COUSETTE (LPC-S)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:COUSETTE
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:RENA
Other - Last Name:COUSETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S
Mailing Address - Street 1:201 TOWNCENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1824
Mailing Address - Country:US
Mailing Address - Phone:205-650-0576
Mailing Address - Fax:205-764-5995
Practice Address - Street 1:201 TOWNCENTER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1824
Practice Address - Country:US
Practice Address - Phone:205-650-0576
Practice Address - Fax:205-764-5995
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2571101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health