DR. THERESA KELLAM (NPI# 1841271772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841271772 |
| Entity Type | Individual |
| Full Name | DR. THERESA KELLAM |
| Credential | PSYCHOLOGIST |
| Practice Address |
2201 Dottie Lynn Parkway Suite 127 Fort Worth TX 76120 |
| Practice Telephone | 8173137899 |
| Practice Fax Number | 8173037278 |
| Mailing Telephone | 8173137899 |
| Mailing Fax Number | 8173037278 |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2009-08-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 32518 | TX | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | PSYCHOLOGIST LICENSE | 32518 | 01 |
| Street Address |
2201 DOTTIE LYNN PARKWAY SUITE 127 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104328673 | Kushum Pokharel | Nurse Practitioner | 9036 Sunridge Circle Apt 236, Fort Worth, TX 76120 | 2018-03-01 |
| 1033636865 | Ehc Institutional LLC | Clinic/Center | 1251 Eastchase Pkwy, Fort Worth, TX 76120 | 2017-08-23 |
| 1205352770 | Jessica Racheel Ferguson | Counselor | 2684 Gardendale Drive, Fort Worth, TX 76120 | 2017-08-16 |
| 1114313772 | John Allen Baker | Registered Nurse | 809 Newport Rd, Fort Worth, TX 76120 | 2015-04-10 |
| 1629475637 | Marklin Holdings Pllc | Dentist | 1476 Eastchase Pkwy, Fort Worth, TX 76120 | 2014-11-20 |
| 1730223793 | Positive Health Managment, Inc. | Clinic/Center | 6816 Manhattan Blvd, Fort Worth, TX 76120 | 2007-02-16 |
| 1487677357 | Fine Spine LLC | Family Medicine | 709 East Loop 820, Fort Worth, TX 76120 | 2006-07-25 |
| 1720045784 | Josie Elizabeth Estes | Psychiatry & Neurology | 7525 John T White, Fort Worth, TX 76120 | 2006-04-26 |
| 1891208088 | Professional Ehc Eastchase LLC | Emergency Medicine | 1251 Eastchase Pkwy, Fort Worth, TX 76120 | 2017-11-09 |
| 1811902125 | Stacy Peters Harris | Chiropractor | 709 East Loop 820, Fort Worth, TX 76120 | 2006-07-29 |
| Find all providers in zip 76120 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1306481205 | Luma Psychology Pllc | Psychologist | 2201 Dottie Lynn Pkwy Ste 127, Fort Worth, TX 76120-4435 | 2019-11-14 |
| 1710484985 | Jordana Elyse Mortimer | Psychologist | 1208 W Magnolia Ave Ste 234, Fort Worth, TX 76104-8801 | 2018-04-12 |
| 1255848750 | William Travis Gardner | Psychologist | 4436 Robertson Rd, Fort Worth, TX 76135-9438 | 2018-01-05 |
| 1760895130 | Mark Schmidt | Psychologist | 6308 Ferncreek Ln, Fort Worth, TX 76179-4701 | 2014-06-03 |
| 1891113676 | Lisa Hensley | Psychologist | 4415 Morris Ct, Fort Worth, TX 76103-3226 | 2014-03-31 |
| 1265781454 | Elizabeth O Oriola-otenaike | Psychologist | 6620 Trinity Heights Blvd, Fort Worth, TX 76132-3578 | 2012-09-03 |
| 1780950436 | Carol Lacey Richardson | Psychologist | 4316 Lake Stone Trl, Fort Worth, TX 76123-8009 | 2012-03-27 |
| 1477834133 | Larry Wayne Carter II | Psychologist | 6100 Western Pl Ste 908, Fort Worth, TX 76107-4600 | 2011-09-07 |
| 1639358385 | Beatrix Wagner | Psychologist | 6300 John Ryan Dr, Fort Worth, TX 76132-4122 | 2007-10-30 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76120 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.