Individual
MRS. KELLY DEATON TOLLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, LPCC
Contact information
Practice address
208 KIDD DR, BEREA, KY 40403-9593
(859) 428-7862
(859) 999-7869
Mailing address
PO BOX 802, BEREA, KY 40403-0802
(859) 428-7862
(859) 999-7869
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPCA KY-1506
KY
101YM0800X
Mental Health Counselor
Primary
LPCC-KY-245479
KY
101YP2500X
Professional Counselor
245479
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100573130
—
KY
Enumeration date
01/28/2013
Last updated
11/03/2023
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