Provider Demographics
NPI:1528215266
Name:KELLENBERGER, DOUGLAS FREEMAN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:FREEMAN
Last Name:KELLENBERGER
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-2126
Mailing Address - Country:US
Mailing Address - Phone:260-410-7565
Mailing Address - Fax:260-456-8425
Practice Address - Street 1:6202 CONSTITUTION DR STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1583
Practice Address - Country:US
Practice Address - Phone:260-432-0066
Practice Address - Fax:260-432-8503
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health