Theresa Kellam, PSYCHOLOGIST

Primary specialty

PsychologistTaxonomy code 103T00000X

License

32518 Issued in TX

Practice address

2201 Dottie Lynn Parkway
Suite 127
Fort Worth, TX 76120

Phone

(817) 313-7899

Fax

(817) 303-7278

NPI assigned

Nov 8, 2005

Last updated

Aug 13, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Luma Psychology PLLC

  dba Theresa Kellam, Ph.D. Licensed Psychologist

  • Psychologist
  • Fort Worth, TX
  • NPI 1306481205
  NPD Authorized official
• Theresa Kellam, PH.D.

  • Community/Behavioral Health Agency
  • Fort Worth, TX
  • NPI 1205248150
  NPD Authorized official

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250121600000",
    "number": "1841271772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 DOTTIE LYNN PARKWAY",
            "address_2": "SUITE 127",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76120",
            "telephone_number": "817-313-7899",
            "fax_number": "817-303-7278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 DOTTIE LYNN PARKWAY",
            "address_2": "SUITE 127",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76120",
            "telephone_number": "817-313-7899",
            "fax_number": "817-303-7278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLAM",
        "first_name": "THERESA",
        "name_prefix": "Dr.",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-08",
        "last_updated": "2009-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "32518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST LICENSE",
            "identifier": "32518",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keith W Louden M D PA
• Ann Keith
• Joshua Keithley, M.D.
• Josephine T Kelebeng
• Howard M Kelfer, MD
• Shane Kelleher, PA-C
• Steven L. Kellenberger, DC
• Keller Crossing Dentistry PLLC
• Keller Desai Dental PLLC (Care 32 Dental)
• Keller Modern Dentistry and Orthodontics, PC (Keller Modern Dentistry and Orthodontics)

• Psychologist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2009; 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.