Provider Demographics
NPI:1316615164
Name:FLORES, KELLIE LYNN
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:LYNN
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E PECAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9506
Mailing Address - Country:US
Mailing Address - Phone:956-451-0694
Mailing Address - Fax:
Practice Address - Street 1:300 E PECAN BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9506
Practice Address - Country:US
Practice Address - Phone:956-451-0694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0134149TELE101YA0400X
TX16106101YA0400X
VT068.0135111TELE101YM0800X
FLTPMC3036101YM0800X
SC449101YP2500X
TX86603101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional