Provider Demographics
NPI:1083438329
Name:JETT, KELLIE DNEACE
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:DNEACE
Last Name:JETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:DNEACE
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5293 S 31ST ST STE 137
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3575
Mailing Address - Country:US
Mailing Address - Phone:254-228-5830
Mailing Address - Fax:254-598-2537
Practice Address - Street 1:3003 DAWN DR STE 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2800
Practice Address - Country:US
Practice Address - Phone:512-688-4303
Practice Address - Fax:254-598-2537
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional