Provider Demographics
NPI:1801213707
Name:MOELLER, KELLY R (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:R
Last Name:MOELLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27802 BOGEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3875
Mailing Address - Country:US
Mailing Address - Phone:210-831-8888
Mailing Address - Fax:
Practice Address - Street 1:27802 BOGEN RD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-3875
Practice Address - Country:US
Practice Address - Phone:210-831-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX355671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27-1287790Medicaid