Provider Demographics
NPI:1124428263
Name:KELLEY, CHERYL (LPC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 PAESANOS PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1266
Mailing Address - Country:US
Mailing Address - Phone:210-481-4265
Mailing Address - Fax:210-851-8374
Practice Address - Street 1:3519 PAESANOS PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1266
Practice Address - Country:US
Practice Address - Phone:210-481-4265
Practice Address - Fax:210-851-8374
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX68281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional