Provider Demographics
NPI:1265777387
Name:KELLAR, KRISTINE (LMHC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:KELLAR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BUMPS RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURKE
Mailing Address - State:VT
Mailing Address - Zip Code:05871-4413
Mailing Address - Country:US
Mailing Address - Phone:802-467-3490
Mailing Address - Fax:
Practice Address - Street 1:530 BUMPS RD
Practice Address - Street 2:
Practice Address - City:WEST BURKE
Practice Address - State:VT
Practice Address - Zip Code:05871-4413
Practice Address - Country:US
Practice Address - Phone:802-467-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0083052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health