Provider Demographics
NPI:1124870050
Name:KING, KELSEY (MA, LPC-A)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 N YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-6378
Mailing Address - Country:US
Mailing Address - Phone:469-865-9369
Mailing Address - Fax:
Practice Address - Street 1:26077 NELSON WAY STE 901
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6694
Practice Address - Country:US
Practice Address - Phone:713-715-7698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional