Provider Demographics
NPI:1487055026
Name:MISKIN, KELLY KRISTINE (MS, LCDC, LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KRISTINE
Last Name:MISKIN
Suffix:
Gender:F
Credentials:MS, LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 WESTERLEIGH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1799
Mailing Address - Country:US
Mailing Address - Phone:210-872-4883
Mailing Address - Fax:
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4801
Practice Address - Country:US
Practice Address - Phone:210-522-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional