Basic Information
| Provider Information | |||||||||
| NPI: | 1306273362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERPOOTEN | ||||||||
| FirstName: | KELLEY | ||||||||
| MiddleName: | CAMILLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCDC, CART, CCJP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1520 COUNTY ROAD 700 | ||||||||
| Address2: | |||||||||
| City: | CLEBURNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760310301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176453370 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 239 S. VIRGINIA STREET | ||||||||
| Address2: | |||||||||
| City: | STEPHENVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2549655515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2013 | ||||||||
| LastUpdateDate: | 10/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 5063 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.