Healthcare Provider Details

I. General information

NPI: 1124870050
Provider Name (Legal Business Name): KELSEY KING BASS M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY KING M.A., LPC

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 N YELLOWSTONE DR
DEER PARK TX
77536-6378
US

IV. Provider business mailing address

1621 N YELLOWSTONE DR
DEER PARK TX
77536-6378
US

V. Phone/Fax

Practice location:
  • Phone: 469-865-9369
  • Fax:
Mailing address:
  • Phone: 469-865-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number94375
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: