Provider Demographics
NPI:1750695466
Name:DEAN, KELLY CHAREESE (LPCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:CHAREESE
Last Name:DEAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:CHAREESE
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:14 LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:JEFF
Mailing Address - State:KY
Mailing Address - Zip Code:41751-9038
Mailing Address - Country:US
Mailing Address - Phone:606-487-0351
Mailing Address - Fax:606-439-0364
Practice Address - Street 1:14 LOGAN DR
Practice Address - Street 2:
Practice Address - City:JEFF
Practice Address - State:KY
Practice Address - Zip Code:41751-9038
Practice Address - Country:US
Practice Address - Phone:606-487-0351
Practice Address - Fax:606-439-0364
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KY274659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator