MEDICARE: DOUGLAS FREEMAN KELLENBERGER MA, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1528215266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS FREEMAN KELLENBERGER MA, LMHC

Provider Business Mailing Address
First Line	:	933 LEXINGTON AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-2126
Country	:	US
Telephone Number	:	260-410-7565
Fax Number	:	260-456-8425

Provider Business Practice Location Address
First Line	:	6202 CONSTITUTION DR STE D
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1583
Country	:	US
Telephone Number	:	260-432-0066
Fax Number	:	260-432-8503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	02/25/2016

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