Provider Demographics
NPI:1477099828
Name:KLUNGLAND, KELLEY RIEDER (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:RIEDER
Last Name:KLUNGLAND
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:NICOLE
Other - Last Name:RIEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 CHESTNUT ST APT 241
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-4521
Mailing Address - Country:US
Mailing Address - Phone:931-247-0608
Mailing Address - Fax:
Practice Address - Street 1:1401 WILLIAMS ST STE 210
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1190
Practice Address - Country:US
Practice Address - Phone:423-207-4712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional