Provider Demographics
NPI:1962125625
Name:LEAL SCALLAN, KAE ABIGAIL
Entity type:Individual
Prefix:
First Name:KAE ABIGAIL
Middle Name:
Last Name:LEAL SCALLAN
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 1:4162 W PIONEER DR APT 2104
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-0676
Mailing Address - Country:US
Mailing Address - Phone:512-876-3359
Mailing Address - Fax:
Practice Address - Street 1:8951 CYPRESS WATERS BLVD STE 160
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4784
Practice Address - Country:US
Practice Address - Phone:469-607-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional