Provider Demographics
NPI:1063798528
Name:ANGLIN, KELLY D (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:D
Last Name:ANGLIN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 N DUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9253
Mailing Address - Country:US
Mailing Address - Phone:505-215-3629
Mailing Address - Fax:855-827-5477
Practice Address - Street 1:303 CADET CT
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-1380
Practice Address - Country:US
Practice Address - Phone:505-215-3629
Practice Address - Fax:888-649-1808
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NM0162711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist