Provider Demographics
NPI:1962978676
Name:HALFORD, KELLI ELIZABETH (LCDC)
Entity type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ELIZABETH
Last Name:HALFORD
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16414 BOUGAINVILLA LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3106
Mailing Address - Country:US
Mailing Address - Phone:281-627-3938
Mailing Address - Fax:
Practice Address - Street 1:7510 FM 1765
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-3672
Practice Address - Country:US
Practice Address - Phone:409-944-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14430101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)