Individual
MRS. LAURA ANN KELLICUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
109 W WATAUGA AVE, JOHNSON CITY, TN 37604-5621
(423) 232-2600
(423) 467-3644
Mailing address
PO BOX 9054, GRAY, TN 37615-9054
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC2799
TN
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
10/24/2006
Last updated
03/06/2012
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