Provider Demographics
NPI:1114582491
Name:JERAY, KELLI J (MA LPC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:J
Last Name:JERAY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 W YELLOWJACKET LN APT 516
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4841
Mailing Address - Country:US
Mailing Address - Phone:469-560-1634
Mailing Address - Fax:
Practice Address - Street 1:3256 SOUTHERN DR STE 461
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1533
Practice Address - Country:US
Practice Address - Phone:469-560-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional