Provider Demographics
NPI:1942327952
Name:KELLY, JAMES ALLEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLEN
Last Name:KELLY
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 1:5200 MARYLAND WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5018
Mailing Address - Country:US
Mailing Address - Phone:615-377-1153
Mailing Address - Fax:615-370-0919
Practice Address - Street 1:5200 MARYLAND WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5018
Practice Address - Country:US
Practice Address - Phone:615-377-1153
Practice Address - Fax:615-370-0919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0085513OtherBCBS PROVIDER NUMBER
TN3690235Medicare ID - Type Unspecified