Individual
KATIE LINN KELLY BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
650 ASHPORT RD, JACKSON, TN 38305-7327
(731) 431-5069
Mailing address
650 ASHPORT RD, JACKSON, TN 38305-7327
(731) 431-5069
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6968
TN
Other
Enumeration date
01/24/2024
Last updated
02/02/2024
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