Provider Demographics
NPI:1063429884
Name:BERRY, KAYRENE K (LPC)
Entity type:Individual
Prefix:MISS
First Name:KAYRENE
Middle Name:K
Last Name:BERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAYRENE
Other - Middle Name:
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 S MAIN ST STE 195
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5011
Mailing Address - Country:US
Mailing Address - Phone:254-383-3403
Mailing Address - Fax:817-697-4435
Practice Address - Street 1:204 S MAIN ST STE 195
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5011
Practice Address - Country:US
Practice Address - Phone:254-383-3403
Practice Address - Fax:817-697-4435
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027848303Medicaid