Provider Demographics
NPI:1790545580
Name:SIGNER, KELLY MARIE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:SIGNER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 BAY CITY BND
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78725-2936
Mailing Address - Country:US
Mailing Address - Phone:720-629-5051
Mailing Address - Fax:
Practice Address - Street 1:6448 E HWY 290 STE E102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1041
Practice Address - Country:US
Practice Address - Phone:512-956-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional