=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427527969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLY DENISE GADBURY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2018
-----------------------------------------------------
Last Update Date | 09/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CHISHOLM TRAIL RD STE 450
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681-5094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-862-7200
-----------------------------------------------------
Fax | 512-862-7205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 CHISHOLM TRAIL RD STE 450
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78681-5094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-862-7200
-----------------------------------------------------
Fax | 512-862-7205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 74054
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------