MEDICARE: DR. KIRLEEN NEELY PHD, LPC-S

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
1	103TB0200X	Cognitive & Behavioral Psychologist	16484	TX
2	106H00000X	Marriage & Family Therapist	16484	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548376387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRLEEN NEELY PHD, LPC-S

Provider Business Mailing Address
First Line	:	12030 BANDERA RD STE D
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4735
Country	:	US
Telephone Number	:	210-523-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	11153 WESTWOOD LOOP STE 122
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-6766
Country	:	US
Telephone Number	:	210-414-8949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	12/21/2021

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