Kelley M Blackwell, LMFT

Key facts

NPI

1720147119

Entity type

Individual (NPI type 1)

Primary specialty

Marriage & Family Therapist 106H00000X

License

567 (TN)

Practice address

795 Holly LN
Waverly, TN 37185

Phone

(931) 296-9813

Fax

(931) 296-9853

NPI assigned

Dec 8, 2006

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 10, 2019.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1720147119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "795 HOLLY LN",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371853392",
            "telephone_number": "931-296-9813",
            "fax_number": "931-296-9853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "795 HOLLY LN",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "37185",
            "telephone_number": "931-296-9813",
            "fax_number": "931-296-9853"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 Holly Ln",
            "address_purpose": "LOCATION",
            "city": "Waverly",
            "state": "TN",
            "postal_code": "371853387",
            "country_code": "US",
            "telephone_number": "931-296-9813",
            "fax_number": "931-296-9853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "KELLEY",
        "middle_name": "M",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-08",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TN",
            "license": "567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Waverly, TN · Marriage & Family Therapist in Tennessee