Provider Demographics
NPI:1104565944
Name:ELLIOTT, KALEA DAION (MHPS)
Entity type:Individual
Prefix:
First Name:KALEA
Middle Name:DAION
Last Name:ELLIOTT
Suffix:
Gender:
Credentials:MHPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211631
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-8631
Mailing Address - Country:US
Mailing Address - Phone:972-665-8944
Mailing Address - Fax:855-282-5709
Practice Address - Street 1:221 BEDFORD RD STE 307
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6251
Practice Address - Country:US
Practice Address - Phone:682-777-5299
Practice Address - Fax:855-282-5709
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1581-0322175T00000X
251S00000X, 171400000X, 171M00000X
TX19037172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer Specialist
No251S00000XAgenciesCommunity/Behavioral Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator