MEDICARE: KELLY MARIE SIGNER LPC, NCC

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	101YP2500X	Professional Counselor	88033	TX

General Provider Information

NPI Number	:	1790545580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE SIGNER LPC, NCC

Provider Business Mailing Address
First Line	:	6448 E HWY 290
Second Line	:	STE E102
City	:	AUSTIN
State	:	TX
Zip	:	78723
Country	:	US
Telephone Number	:	512-956-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	6448 E HWY 290
Second Line	:	STE E102
City	:	AUSTIN
State	:	TX
Zip	:	78723
Country	:	US
Telephone Number	:	512-956-8868
Fax Number	:

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

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/02/2026

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