Provider Demographics
NPI:1114471927
Name:MCKELVY, TARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:MCKELVY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 W ROSEDALE ST
Mailing Address - Street 2:STE 305
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:682-841-1475
Mailing Address - Fax:
Practice Address - Street 1:12801 N CENTRAL EXPY
Practice Address - Street 2:1730
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1716
Practice Address - Country:US
Practice Address - Phone:469-751-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist