Provider Demographics
NPI:1659101228
Name:KILLEBREW, DELANEY WRAY
Entity type:Individual
Prefix:
First Name:DELANEY
Middle Name:WRAY
Last Name:KILLEBREW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 CAIN HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-1158
Mailing Address - Country:US
Mailing Address - Phone:812-870-3903
Mailing Address - Fax:
Practice Address - Street 1:2678 TOWNSEND CT UNIT C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8120
Practice Address - Country:US
Practice Address - Phone:931-201-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty