Provider Demographics
NPI:1104477314
Name:SALZMAN, KELLY M (LPC, LPC-SUPERVISOR)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:SALZMAN
Suffix:
Gender:F
Credentials:LPC, LPC-SUPERVISOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 BLUESTONE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-6929
Mailing Address - Country:US
Mailing Address - Phone:817-300-8735
Mailing Address - Fax:
Practice Address - Street 1:10700 BLUESTONE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-6929
Practice Address - Country:US
Practice Address - Phone:817-300-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional