Provider Demographics
NPI:1538394796
Name:KEMP, ELLYN PATRICE (MED, LMSW)
Entity type:Individual
Prefix:MS
First Name:ELLYN
Middle Name:PATRICE
Last Name:KEMP
Suffix:
Gender:F
Credentials:MED, LMSW
Other - Prefix:MS
Other - First Name:ELLYN
Other - Middle Name:PATRICE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LMSW
Mailing Address - Street 1:275 CUMBERLAND BND
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1805
Mailing Address - Country:US
Mailing Address - Phone:615-744-7443
Mailing Address - Fax:615-687-1798
Practice Address - Street 1:275 CUMBERLAND BND
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1805
Practice Address - Country:US
Practice Address - Phone:615-744-7443
Practice Address - Fax:615-687-1798
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000004769104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker