Kellam, Theresa

Kellam, Theresa is an sole proprietor health care provider with primary practice located at 2201 Dottie Lynn Parkway Suite 127, Fort Worth TX 76120. She recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as her primary health care specialty. Kellam, Theresa can be contacted via phone (817) 313-7899.

Contact Information

Primary practice address
2201 Dottie Lynn Parkway Suite 127 Fort Worth TX 76120
Fax: (817) 303-7278
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 32518 Texas

Profile Details

NPI number 1841271772
LBN Legal business name Kellam, Theresa
Credentials PSYCHOLOGIST
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 8th, 2005
Last updated Aug 13th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841271772 NPPES
Texas Other 32518 PSYCHOLOGIST LICENSE

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