Provider Demographics
NPI:1073332128
Name:KALLMI, SELMI (PHD)
Entity type:Individual
Prefix:
First Name:SELMI
Middle Name:
Last Name:KALLMI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 OAK LAWN AVE APT 242
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5625
Mailing Address - Country:US
Mailing Address - Phone:314-601-4686
Mailing Address - Fax:
Practice Address - Street 1:2929 OAK LAWN AVE APT 242
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5625
Practice Address - Country:US
Practice Address - Phone:314-601-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122110103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical