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1 Chisholm Trail Rd Ste 450 Round Rock TX 78681-5094 | |
| (512) 862-7200 | |
| (512) 862-7205 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1 Chisholm Trail Rd Ste 450, Round Rock, Texas |
| Authorized Official Name and Position | Kelly Denise Gadbury (OWNER) |
| Authorized Official Contact | 5128627200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1 Chisholm Trail Rd Suite 450 Round Rock TX 78726-4208 Ph: (512) 862-7200 | 1 Chisholm Trail Rd Ste 450 Round Rock TX 78681-5094 Ph: (512) 862-7200 |
| NPI Number | 1215492368 |
|---|---|
| Provider Enumeration Date | 02/04/2019 |
| Last Update Date | 01/03/2025 |
| Certification Date | 01/01/2025 |
| Medicare PECOS PAC ID | 6507390424 |
|---|---|
| Medicare Enrollment ID | O20241114000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215492368 | NPI | - | NPPES |
| 4195265 | Medicaid | TX | |
| 4195257 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Kelly Denise Gadbury |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427527969 PECOS PAC ID: 3072954627 Enrollment ID: I20240514000513 |
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