Individual
KELLI FOULKROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4534 W GATE BLVD, SUITE 112, AUSTIN, TX 78745-1485
(512) 553-1563
Mailing address
6604 BAY CITY BND, AUSTIN, TX 78725-2933
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
34465
TX
Other
Enumeration date
05/04/2015
Last updated
05/04/2015
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