MEDICARE: MRS. JAMIE DENISE KELLEY

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1609010487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE DENISE KELLEY

Provider Business Mailing Address
First Line	:	3117 LUXAR WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-1636
Country	:	US
Telephone Number	:	214-676-2915
Fax Number	:	214-821-6505

Provider Business Practice Location Address
First Line	:	3117 LUXAR WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-1636
Country	:	US
Telephone Number	:	214-676-2915
Fax Number	:	214-821-6505

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

Provider Enumeration Date	:	04/24/2009
Last Update Date	:	04/24/2009

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Directions to “ MRS. JAMIE DENISE KELLEY ” Practice Location

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