Provider Demographics
NPI:1336507516
Name:FROST, KELLEY (PHD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 BROADWAY ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5747
Mailing Address - Country:US
Mailing Address - Phone:210-386-0014
Mailing Address - Fax:
Practice Address - Street 1:4940 BROADWAY ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5747
Practice Address - Country:US
Practice Address - Phone:210-386-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional