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General NPI Number Information
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NPI Number | 1932595444
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Entity Type | Organization
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Legal Business Name | KELLIE MCLARTY LPC
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 4200 S HULEN ST SUITE 318
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City | FORT WORTH
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State | TX
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Zip | 76109-4914
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Country | US
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Telephone | 817-296-6053
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 HULEN ST. SUITE 318
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City | FORT WORTH
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State | TX
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Zip | 76109
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Country | US
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Telephone | 817-296-6053
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Fax |
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Authorized Official
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Title or Position | LPC, LCDC
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Name | MRS. KELLIE A MCLARTY
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Credential | M.ED.
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Telephone | 817-296-6053
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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 | 7917
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License Number State | TX
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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 | 19717
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License Number State | TX
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