Provider Demographics
NPI:1164579751
Name:KELLERMAN, ALAN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:A
Last Name:KELLERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 APACHE PLUME DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2600
Mailing Address - Country:US
Mailing Address - Phone:713-623-2861
Mailing Address - Fax:
Practice Address - Street 1:50 BRIAR HOLLOW LN
Practice Address - Street 2:STE 650E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-9371
Practice Address - Country:US
Practice Address - Phone:713-623-6861
Practice Address - Fax:713-623-2972
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22317103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31790667Medicaid
TX31790667Medicaid
R58872Medicare UPIN