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General NPI Number Information
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NPI Number | 1679813083
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Entity Type | Individual
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Provider Name | DAVID EARL KELLAR LMLP
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Gender | Male
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Dates
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Enumeration Date | 02/21/2013
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 10816 CROWN COLONY DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78747-1639
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Country | US
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Telephone | 855-284-7483
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Fax |
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Provider Business Mailing Address
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Address Line | 1748 W NORMANDY ST
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City | OLATHE
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State | KS
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Zip | 66061-3811
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Country | US
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Telephone | 913-972-0451
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 344
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 93941
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License Number State | TX
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