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General NPI Number Information
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NPI Number | 1629087457
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Entity Type | Individual
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Provider Name | KELLY M PAULK M.A., L.P.C
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2003 PATTERSON DR
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City | VICTORIA
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State | TX
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Zip | 77901-5645
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Country | US
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Telephone | 361-575-5021
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Fax | 361-575-0623
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Provider Business Mailing Address
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Address Line | 2003 PATTERSON DR
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City | VICTORIA
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State | TX
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Zip | 77901-5645
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Country | US
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Telephone | 361-575-5021
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Fax | 361-575-0623
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19304
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License Number State | TX
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