Provider Demographics
NPI:1760099675
Name:KELLING, JENNIFER SUE (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:KELLING
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 S HIGHWAY 78 STE 100
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3957
Mailing Address - Country:US
Mailing Address - Phone:469-342-3468
Mailing Address - Fax:
Practice Address - Street 1:303 S HIGHWAY 78 STE 100
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3957
Practice Address - Country:US
Practice Address - Phone:469-342-3468
Practice Address - Fax:469-342-3466
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84290101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor