Provider Demographics
NPI:1962064402
Name:DEMORY GUEVARA, KELLY L (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:DEMORY GUEVARA
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:DEMORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC INTERN
Mailing Address - Street 1:5151 FLYNN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4318
Mailing Address - Country:US
Mailing Address - Phone:956-405-2106
Mailing Address - Fax:
Practice Address - Street 1:5151 FLYNN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4318
Practice Address - Country:US
Practice Address - Phone:956-405-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional