| Doctor Name: | KRISTINE KELLAR |
| NPI Number: | 1265777387 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | 068.0083052 |
| Business Practice Address: | 530 Bumps Rd West Burke, VT - 058714413 |
| Business Phone Number: | 8024673490 |
| Business Fax Number: | |
| Mailing Address: | 530 Bumps Rd, WEST BURKE |
| State: | VT |
| Postal Code: | 058714413 |
| Phone Number: | 8024673490 |
| Fax Number: | |
| NPI Enumeration Date: | 11/29/2012 |
| NPI Last Update Date: | 11/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 068.0083052 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |