Theresa Kellam, PH.D.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

32518 Issued in TX

Legal business name

THERESA KELLAM, PH.D.

Practice address

2201 Dottie Lynn Pkwy
Suite 127
Fort Worth, TX 76120-4432

Phone

(817) 313-7899

NPI assigned

May 27, 2014

Last updated

May 27, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Theresa Kellam, PH.D.NPI 1841271772

Title

Owner/Psychologist

Phone

(817) 313-7899

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Theresa Kellam, PSYCHOLOGIST

  • Psychologist
  • Fort Worth, TX
  • NPI 1841271772
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1205248150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 DOTTIE LYNN PKWY",
            "address_2": "SUITE 127",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761204432",
            "telephone_number": "817-313-7899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 DOTTIE LYNN PKWY",
            "address_2": "SUITE 127",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761204432",
            "telephone_number": "817-313-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESA KELLAM, PH.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "KELLAM",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "817-313-7899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "TX",
            "license": "32518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shaederrica Theus
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• Community/Behavioral Health Agency in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Community/Behavioral Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.