Provider Demographics
NPI:1205580339
Name:HATLEY, KRISTI RACHELLE (LPC, CCTP, QMHP)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:RACHELLE
Last Name:HATLEY
Suffix:
Gender:F
Credentials:LPC, CCTP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-6416
Mailing Address - Country:US
Mailing Address - Phone:423-737-5382
Mailing Address - Fax:
Practice Address - Street 1:667 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-6416
Practice Address - Country:US
Practice Address - Phone:423-737-5382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00000000000000000Medicaid