Provider Demographics
NPI:1992522346
Name:KELLY, NICOLE MARIE (LPC-A, NCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-3787
Mailing Address - Country:US
Mailing Address - Phone:469-486-4889
Mailing Address - Fax:
Practice Address - Street 1:5665 DALLAS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7378
Practice Address - Country:US
Practice Address - Phone:469-402-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional