Provider Demographics
NPI:1427796226
Name:KELLY, LIAM (MS, LPC-ASSOCIATE)
Entity type:Individual
Prefix:MR
First Name:LIAM
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:MS, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 EMERY ST STE 530
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2478
Mailing Address - Country:US
Mailing Address - Phone:940-268-4287
Mailing Address - Fax:
Practice Address - Street 1:2214 EMERY ST STE 530
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2478
Practice Address - Country:US
Practice Address - Phone:940-268-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87162101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor