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NPI Code Detail

MEDICARE: MR. DAVID EARL KELLAR LMLP

MEDICARE: MR. DAVID EARL KELLAR LMLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor344KS
2101YP2500XProfessional Counselor93941TX

General Provider Information

NPI Number : 1679813083
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID EARL KELLAR LMLP
Provider Business Mailing Address
First Line : 1748 W NORMANDY ST
Second Line :
City : OLATHE
State : KS
Zip : 66061-3811
Country : US
Telephone Number : 913-972-0451
Fax Number :
Provider Business Practice Location Address
First Line : 10816 CROWN COLONY DR STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78747-1639
Country : US
Telephone Number : 855-284-7483
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2013
Last Update Date : 03/07/2024

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