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General NPI Number Information
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NPI Number | 1679003362
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Entity Type | Organization
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Legal Business Name | KELLY M. MCCABE, LPC-S, LMFT-S, PLLC
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3007 DAWN DR STE 106
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City | GEORGETOWN
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State | TX
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Zip | 78628-2864
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Country | US
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Telephone | 512-688-5615
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Fax |
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Provider Business Mailing Address
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Address Line | 3007 DAWN DR STE 106
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City | GEORGETOWN
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State | TX
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Zip | 78628-2864
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Country | US
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Telephone | 512-688-5615
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KELLY MICHELLE MCCABE
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Credential | LPC-S, LMFT-S
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Telephone | 512-688-5615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17640
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 5074
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License Number State | TX
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