Provider Demographics
NPI:1609010487
Name:KELLEY, JAMIE DENISE
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:DENISE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 LUXAR WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75233-1636
Mailing Address - Country:US
Mailing Address - Phone:214-676-2915
Mailing Address - Fax:214-821-6505
Practice Address - Street 1:3117 LUXAR WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75233-1636
Practice Address - Country:US
Practice Address - Phone:214-676-2915
Practice Address - Fax:214-821-6505
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor