Provider Demographics
NPI:1679003362
Name:KELLY M. MCCABE, LPC-S, LMFT-S, PLLC
Entity Type:Organization
Organization Name:KELLY M. MCCABE, LPC-S, LMFT-S, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, LMFT-S
Authorized Official - Phone:512-688-5615
Mailing Address - Street 1:3007 DAWN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2864
Mailing Address - Country:US
Mailing Address - Phone:512-688-5615
Mailing Address - Fax:
Practice Address - Street 1:3007 DAWN DR STE 106
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2864
Practice Address - Country:US
Practice Address - Phone:512-688-5615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17640101YP2500X
TX5074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty