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General NPI Number Information
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NPI Number | 1457123051
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Entity Type | Individual
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Provider Name | KELLI RAYN REDD M.ED., LPC-ASSOCIATE
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Gender | Female
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 11340 EAGLE DR
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City | MONT BELVIEU
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State | TX
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Zip | 77523-7640
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Country | US
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Telephone | 832-262-3197
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Fax |
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Provider Business Mailing Address
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Address Line | 4302 S FM 565 RD
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City | BAYTOWN
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State | TX
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Zip | 77523-9459
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Country | US
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Telephone | 832-545-5710
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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 | 92668
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License Number State | TX
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