Provider Demographics
NPI:1760750335
Name:MCKELVY, TAMMIE SUE (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:SUE
Last Name:MCKELVY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N VICTOR ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-2682
Mailing Address - Country:US
Mailing Address - Phone:325-330-3500
Mailing Address - Fax:325-356-1459
Practice Address - Street 1:202 N VICTOR ST
Practice Address - Street 2:SUITE B
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-2682
Practice Address - Country:US
Practice Address - Phone:325-330-3500
Practice Address - Fax:325-356-1459
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional