Provider Demographics
NPI:1437342425
Name:HART, KELLY JO (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JO
Last Name:HART
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 OLD CLARKSVILLE SPGFLD RD
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:TN
Mailing Address - Zip Code:37010-8908
Mailing Address - Country:US
Mailing Address - Phone:910-644-2410
Mailing Address - Fax:
Practice Address - Street 1:3149 OLD CLARKSVILLE SPGFLD RD
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:TN
Practice Address - Zip Code:37010-8908
Practice Address - Country:US
Practice Address - Phone:910-644-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6609101Y00000X
CO19353101Y00000X
NC13233101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6609OtherLPC
NC13233OtherLPC
CO19353OtherLPC