Individual
KELLY HODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-MHSP
Contact information
Practice address
441 E BROAD ST STE D, COOKEVILLE, TN 38501-3390
(931) 265-5706
Mailing address
441 E BROAD ST STE D, COOKEVILLE, TN 38501-3390
(931) 265-5706
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3916
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q052793
—
TN
Enumeration date
11/05/2013
Last updated
11/16/2019
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