Provider Demographics
NPI:1679711717
Name:MCPFIMELORONTI, KELLY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:MCPFIMELORONTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:137 RAINBOW DR
Mailing Address - Street 2:3795
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-1037
Mailing Address - Country:US
Mailing Address - Phone:910-394-4700
Mailing Address - Fax:910-394-4711
Practice Address - Street 1:137 RAINBOW DR
Practice Address - Street 2:3795
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77399-1037
Practice Address - Country:US
Practice Address - Phone:910-394-4700
Practice Address - Fax:910-394-4711
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04173103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical