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General NPI Number Information
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NPI Number | 1912364621
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Entity Type | Individual
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Provider Name | KELLIE DYSON LMHC-D
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Gender | Female
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 2385 ARTHUR AVE STE 201
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City | BRONX
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State | NY
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Zip | 10458-8184
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Country | US
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Telephone | 774-206-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 517 UNDERHILL AVE
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City | BRONX
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State | NY
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Zip | 10473-2923
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Country | US
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Telephone |
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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 | 006989
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License Number State | NY
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