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General NPI Number Information
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NPI Number | 1306361431
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Entity Type | Individual
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Provider Name | KELLEY PHILLIPS LPC
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Gender | Female
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 204 E MAIN ST STE C
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City | CROWLEY
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State | TX
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Zip | 76036-2650
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Country | US
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Telephone | 817-618-3988
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 S HULEN ST STE 124-694
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City | FORT WORTH
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State | TX
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Zip | 76109-1914
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Country | US
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Telephone | 817-618-3988
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 68597
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License Number State | TX
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