Healthcare Provider Details

I. General information

NPI: 1699914416
Provider Name (Legal Business Name): KIA JEANINE HART MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10761 PEBBLE HILLS BLVD STE F
EL PASO TX
79935-2037
US

IV. Provider business mailing address

PO BOX 371113
EL PASO TX
79937-1113
US

V. Phone/Fax

Practice location:
  • Phone: 915-594-8685
  • Fax: 866-596-6125
Mailing address:
  • Phone: 915-594-8685
  • Fax: 866-596-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19323
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: