Healthcare Provider Details

I. General information

NPI: 1164288429
Provider Name (Legal Business Name): KOALITY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 MADRID ST # 2
CASTROVILLE TX
78009-4527
US

IV. Provider business mailing address

413 MADRID ST # 2
CASTROVILLE TX
78009-4527
US

V. Phone/Fax

Practice location:
  • Phone: 210-262-2807
  • Fax:
Mailing address:
  • Phone: 210-262-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: DR. KIMBERLEY KAY GASKILL
Title or Position: DIRECTOR
Credential: EDD, LPC-S, CSC
Phone: 210-241-5423