Individual
DR. THERESA KELLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
2201 DOTTIE LYNN PARKWAY, SUITE 127, FORT WORTH, TX 76120
(817) 313-7899
(817) 303-7278
Mailing address
2201 DOTTIE LYNN PARKWAY, SUITE 127, FORT WORTH, TX 76120
(817) 313-7899
(817) 303-7278
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
32518
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32518
PSYCHOLOGIST LICENSE
TX
Enumeration date
11/08/2005
Last updated
08/13/2009
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