Provider Demographics
NPI:1134254493
Name:KELLEY, KAREN SUE (MS, MED, LPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS, MED, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 RAWLINS ST
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4217
Mailing Address - Country:US
Mailing Address - Phone:214-520-7575
Mailing Address - Fax:214-520-7579
Practice Address - Street 1:3710 RAWLINS ST
Practice Address - Street 2:SUITE 1370
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4217
Practice Address - Country:US
Practice Address - Phone:214-520-7575
Practice Address - Fax:214-520-7579
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC TX 11770101YP2500X
TXLMFT 3549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist