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General NPI Number Information
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NPI Number | 1184251845
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Entity Type | Individual
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Provider Name | GUILLERMO ANTONIO KELLY
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Gender | Male
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 1901 VETERANS MEMORIAL DR
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City | TEMPLE
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State | TX
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Zip | 76504-7451
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Country | US
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Telephone | 254-778-4811
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GABRIELS BLUFF DR APT 2304
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City | GEORGETOWN
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State | TX
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Zip | 78626-2598
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Country | US
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Telephone | 915-474-1893
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 69132
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License Number State | TX
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