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General NPI Number Information
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NPI Number | 1992522346
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Entity Type | Individual
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Provider Name | NICOLE MARIE KELLY LPC-A, NCC
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Gender | Female
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 5665 DALLAS PKWY STE 150
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City | FRISCO
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State | TX
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Zip | 75034-7378
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Country | US
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Telephone | 469-402-1292
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Fax |
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Provider Business Mailing Address
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Address Line | 1504 HIGHLAND CIR
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City | LITTLE ELM
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State | TX
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Zip | 75068-3787
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Country | US
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Telephone | 469-486-4889
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 96596
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License Number State | TX
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