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General NPI Number Information
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NPI Number | 1508203803
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Entity Type | Individual
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Provider Name | KATHLEEN STORY LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 2105 W LOUISIANA AVE
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City | MIDLAND
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State | TX
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Zip | 79701-5919
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Country | US
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Telephone | 432-682-5683
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Fax |
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Provider Business Mailing Address
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Address Line | 5010 W LOOP 250 N SUITE 6C
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City | MIDLAND
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State | TX
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Zip | 79707-3116
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Country | US
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Telephone | 432-258-8108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201624
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License Number State | TX
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