Provider Demographics
NPI:1457123051
Name:REDD, KELLI RAYN (MED, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:RAYN
Last Name:REDD
Suffix:
Gender:F
Credentials:MED, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 S FM 565 RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-9459
Mailing Address - Country:US
Mailing Address - Phone:832-545-5710
Mailing Address - Fax:
Practice Address - Street 1:11340 EAGLE DR
Practice Address - Street 2:
Practice Address - City:MONT BELVIEU
Practice Address - State:TX
Practice Address - Zip Code:77523-7640
Practice Address - Country:US
Practice Address - Phone:832-262-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health