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NPI Code Detail

MEDICARE: KALEIDOSCOPE COUNSELING, PLLC

MEDICARE: KALEIDOSCOPE COUNSELING, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor63431TX

General Provider Information

NPI Number : 1023542420
Entity Type Code : Organization
Provider Name (Legal Business Name) : KALEIDOSCOPE COUNSELING, PLLC
Provider Business Mailing Address
First Line : 82 BLUE THORN TRL
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78256-1639
Country : US
Telephone Number : 210-250-1285
Fax Number :
Provider Business Practice Location Address
First Line : 14603 HUEBNER RD BLDG 6
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78230-5475
Country : US
Telephone Number : 210-239-1285
Fax Number :
Authorized Official
Title or Position : COUNSELOR
Name : KELLI MATHIAS
Credential : LPC
Telephone Number : 210-250-1285
Provider Enumeration Date : 04/12/2017
Last Update Date : 04/12/2017

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Directions to “KALEIDOSCOPE COUNSELING, PLLC ” Practice Location

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