Basic Information
Provider Information
NPI: 1760732432
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEY
FirstName: EMILY
MiddleName: GAYLE
NamePrefix: MRS.
NameSuffix:  
Credential: M.A., NCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1167 SPRATLIN PARK DR
Address2:  
City: GRAY
State: TN
PostalCode: 376156205
CountryCode: US
TelephoneNumber: 4234673600
FaxNumber: 4234673644
Practice Location
Address1: 1570 WAVERLY RD
Address2:  
City: KINGSPORT
State: TN
PostalCode: 376642523
CountryCode: US
TelephoneNumber: 4232241300
FaxNumber: 4234673644
Other Information
ProviderEnumerationDate: 09/10/2012
LastUpdateDate: 01/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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