Provider Demographics
NPI:1962881581
Name:HOLYFIELD, KALI (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:HOLYFIELD
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PALM DR
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-5282
Mailing Address - Country:US
Mailing Address - Phone:214-558-1554
Mailing Address - Fax:
Practice Address - Street 1:5015 S IH 35 STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-2714
Practice Address - Country:US
Practice Address - Phone:214-558-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12776101YA0400X
TX72260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)