Individual
CHARITY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
414 N MAIN ST UNIT 103, GRAPEVINE, TX 76051-3395
(817) 385-5684
Mailing address
414 N MAIN ST UNIT 103, GRAPEVINE, TX 76051-3395
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
205063
TX
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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