Provider Demographics
NPI:1649218439
Name:KELTON, KAMALA JEAN (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:KAMALA
Middle Name:JEAN
Last Name:KELTON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S MAIN ST
Mailing Address - Street 2:BOX 4
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1556
Mailing Address - Country:US
Mailing Address - Phone:802-244-7937
Mailing Address - Fax:802-244-7937
Practice Address - Street 1:55 S MAIN ST
Practice Address - Street 2:BOX 4
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1556
Practice Address - Country:US
Practice Address - Phone:802-244-7937
Practice Address - Fax:802-244-7937
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007352Medicaid