Healthcare Provider Details

I. General information

NPI: 1912364621
Provider Name (Legal Business Name): KELLIE DYSON LMHC-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 ARTHUR AVE STE 201
BRONX NY
10458-8184
US

IV. Provider business mailing address

517 UNDERHILL AVE
BRONX NY
10473-2923
US

V. Phone/Fax

Practice location:
  • Phone: 774-206-1125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: