Provider Information for 1568622421
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Dr. KENNETH A MCKELLAR Sr. LPC. PhD
Sex: Male
NPI: 1568622421
Last Updated: 2008-06-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1568622421 | ||||||||
| Enumeration Date | 2008-06-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1354 REGU RD FREDERICKSBURG, TX 78624-6963 United States Phone: 210-475-2555 | Fax: | ||||||||
| Primary Practice Address | 1354 REGU RD FREDERICKSBURG, TX 78624-6963 United States Phone: 210-475-2555 | Fax: | ||||||||
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