Provider Demographics
NPI:1548756000
Name:FREEMAN, KELLY M (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 37TH AVE N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-3723
Mailing Address - Country:US
Mailing Address - Phone:832-923-4110
Mailing Address - Fax:
Practice Address - Street 1:2314 37TH AVE N
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-3723
Practice Address - Country:US
Practice Address - Phone:832-923-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80029101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor