Provider Demographics
NPI:1639762396
Name:SOOY, KAELIE (LCSW)
Entity type:Individual
Prefix:
First Name:KAELIE
Middle Name:
Last Name:SOOY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAELIE
Other - Middle Name:
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1516 16TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-2060
Mailing Address - Country:US
Mailing Address - Phone:615-952-1205
Mailing Address - Fax:
Practice Address - Street 1:95 WHITE BRIDGE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1498
Practice Address - Country:US
Practice Address - Phone:615-952-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000012069104100000X
TNLSW00000084651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker