Provider Demographics
NPI:1962745042
Name:MCKELLAR, DONNA SUE LEE (LPC)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:SUE LEE
Last Name:MCKELLAR
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 1:1354 REGU RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-6963
Mailing Address - Country:US
Mailing Address - Phone:210-722-4052
Mailing Address - Fax:210-745-4269
Practice Address - Street 1:1354 REGU RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-6963
Practice Address - Country:US
Practice Address - Phone:830-669-2804
Practice Address - Fax:210-745-4269
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional