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
Phone: (817) 313-7899
Fax: (817) 303-7278
Website:
Health care specialties
| Specialty | Code | License # | 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 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841271772 | NPPES |
| Texas | Other | 32518 | PSYCHOLOGIST LICENSE |
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