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General NPI Number Information
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NPI Number | 1720598576
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Entity Type | Organization
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Legal Business Name | DALLAS THERAPY COLLECTIVE, PLLC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 8140 WALNUT HILL LN
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City | DALLAS
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State | TX
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Zip | 75231-4350
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Country | US
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Telephone | 479-879-6051
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Fax | 479-879-6051
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Provider Business Mailing Address
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Address Line | 3340 LEAHY DR
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City | DALLAS
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State | TX
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Zip | 75229-3852
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Country | US
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Telephone | 479-879-6051
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/PSYCHOLOGIST
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Name | DR. KATHRYN KELLER
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Credential |
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Telephone | 479-879-6051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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