Provider Demographics
NPI:1497124069
Name:KELLYS HOME THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:KELLYS HOME THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-309-1981
Mailing Address - Street 1:308 OAK HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2527
Mailing Address - Country:US
Mailing Address - Phone:281-309-1981
Mailing Address - Fax:832-284-4732
Practice Address - Street 1:308 OAK HARBOR DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2527
Practice Address - Country:US
Practice Address - Phone:281-309-1981
Practice Address - Fax:832-284-4732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3094732-02Medicaid