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NPI Code Detail

MEDICARE: MR. BART WILLIAM KELLY LPC

MEDICARE: MR. BART WILLIAM KELLY LPC
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
1101YP2500XProfessional Counselor3951TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16431LCOTHERTXBLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number : 1699887224
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BART WILLIAM KELLY LPC
Provider Business Mailing Address
First Line : 4827 E BEVERLY MAE DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4935
Country : US
Telephone Number : 210-710-4915
Fax Number : 210-822-1790
Provider Business Practice Location Address
First Line : 1978 BABCOCK RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78229-4512
Country : US
Telephone Number : 210-710-4915
Fax Number : 210-822-1790
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/09/2007

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Directions to “ MR. BART WILLIAM KELLY LPC” Practice Location

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