Provider Demographics
NPI:1750533105
Name:KELLEY, JESSICA EVE (LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EVE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 FRANKLIN LN
Mailing Address - Street 2:
Mailing Address - City:WILMER
Mailing Address - State:AL
Mailing Address - Zip Code:36587-9336
Mailing Address - Country:US
Mailing Address - Phone:423-605-7632
Mailing Address - Fax:
Practice Address - Street 1:10455 FRANKLIN LN
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:AL
Practice Address - Zip Code:36587-9336
Practice Address - Country:US
Practice Address - Phone:423-605-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL496101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA