Provider Demographics
NPI:1912560392
Name:CALLAWAY, KELBI JADE (LPC)
Entity Type:Individual
Prefix:
First Name:KELBI
Middle Name:JADE
Last Name:CALLAWAY
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 1:1410 ROBINSON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2848
Mailing Address - Country:US
Mailing Address - Phone:972-523-0000
Mailing Address - Fax:
Practice Address - Street 1:1410 ROBINSON RD STE 400
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2848
Practice Address - Country:US
Practice Address - Phone:972-523-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health