Provider Demographics
NPI:1932595444
Name:KELLIE MCLARTY LPC
Entity Type:Organization
Organization Name:KELLIE MCLARTY LPC
Other - Org Name:KELLIE MCLARTY LPC
Other - Org Type:Other Name
Authorized Official - Title/Position:LPC, LCDC
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCLARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:817-296-6053
Mailing Address - Street 1:4200 HULEN ST.
Mailing Address - Street 2:SUITE 318
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-296-6053
Mailing Address - Fax:
Practice Address - Street 1:4200 S HULEN ST
Practice Address - Street 2:SUITE 318
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4914
Practice Address - Country:US
Practice Address - Phone:817-296-6053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7917101YA0400X
TX19717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty