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General NPI Number Information
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NPI Number | 1033514872
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Entity Type | Organization
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Legal Business Name | KLS COUNSELING & CONSULTING SERVICES
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 214 S MAIN ST SUITE 214
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City | DUNCANVILLE
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State | TX
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Zip | 75116-4700
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Country | US
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Telephone | 469-407-0381
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Fax | 972-572-1069
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Provider Business Mailing Address
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Address Line | 1218 TEAKWOOD DR
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City | DUNCANVILLE
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State | TX
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Zip | 75137-3617
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Country | US
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Telephone | 716-400-8301
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Fax | 972-572-1069
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBER SHELTON
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Credential | PHD
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Telephone | 716-400-8301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 36677
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License Number State | TX
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