Provider Demographics
NPI:1114170305
Name:HUNTER, KELLY L (PSYD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:HUNTER
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12132 BELLA PALAZZO DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2134
Mailing Address - Country:US
Mailing Address - Phone:817-301-3621
Mailing Address - Fax:
Practice Address - Street 1:1300 S UNIVERSITY DR STE 306
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5746
Practice Address - Country:US
Practice Address - Phone:844-824-8775
Practice Address - Fax:281-648-2200
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38496103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201651101Medicaid
TX87968AOtherBCBS
TXP00998015OtherRAILROAD MEDICARE
TXP00998015OtherRAILROAD MEDICARE