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General NPI Number Information
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NPI Number | 1841271772
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Entity Type | Individual
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Provider Name | THERESA KELLAM PSYCHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 2201 DOTTIE LYNN PARKWAY SUITE 127
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City | FORT WORTH
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State | TX
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Zip | 76120
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Country | US
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Telephone | 817-313-7899
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Fax | 817-303-7278
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Provider Business Mailing Address
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Address Line | 2201 DOTTIE LYNN PARKWAY SUITE 127
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City | FORT WORTH
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State | TX
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Zip | 76120
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Country | US
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Telephone | 817-313-7899
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Fax | 817-303-7278
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32518
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License Number State | TX
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