Provider Demographics
NPI:1003092164
Name:KELLOGG, TODD THOMAS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:THOMAS
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 MAIN ST
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1354
Mailing Address - Country:US
Mailing Address - Phone:203-543-2043
Mailing Address - Fax:
Practice Address - Street 1:6515 MAIN ST
Practice Address - Street 2:SUITE LL1
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1354
Practice Address - Country:US
Practice Address - Phone:203-543-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist