Kelly Lynn Cheatham, PHD, LPC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

65475 Issued in TX

Practice address

2535 E Southlake Blvd Ste 220
Southlake, TX 76092-6629

Phone

(817) 228-1668

Fax

(469) 776-0669

NPI assigned

Sep 7, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Zoetry Counseling, PLLC

  • Professional Counselor
  • Southlake, TX
  • NPI 1821687880
  NPD Authorized official

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

{
    "created_epoch": "1283817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1609183094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 E SOUTHLAKE BLVD STE 220",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926629",
            "telephone_number": "817-228-1668",
            "fax_number": "469-776-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2535 E SOUTHLAKE BLVD STE 220",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926629",
            "telephone_number": "817-228-1668",
            "fax_number": "469-776-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEATHAM",
        "first_name": "KELLY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC-S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-07",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "65475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chapel Crossing Concierge Medicine PLLC
• Hayley Chapman
• Timothy Chapman, DC
• Charis Behavioral Health LLC
• Charles B Russey
• Sally Chee Spieldenner, PT
• Miranda K Cheib, C-NP
• David Shie Chiang, OD
• Theresa Chibuoke, NURSE PRACTITIONER
• Chiro One Wellness Center of South Lake PLLC

• Professional Counselor in Southlake, TX
• Providers in Southlake, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; 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.