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Individual
KELLY FENTER
Active
Individual
KELLY FENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
63749
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220239201
—
TX
01
—
89904L
BCBS
—
Enumeration date
10/28/2010
Last updated
11/14/2011
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