Provider Demographics
NPI:1114154838
Name:MCKELLAR, EMMA (MFT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:MCKELLAR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 E WARM SPRINGS RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3185
Mailing Address - Country:US
Mailing Address - Phone:702-281-4307
Mailing Address - Fax:702-547-4307
Practice Address - Street 1:321 N MALL DR STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7302
Practice Address - Country:US
Practice Address - Phone:702-281-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-20
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9542510-3902106H00000X
NV01107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist