Provider Demographics
NPI:1871079418
Name:AKINS, KELLEY KRISTINA (LPC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:KRISTINA
Last Name:AKINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 MAIN ST APT 201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-4055
Mailing Address - Country:US
Mailing Address - Phone:214-325-9343
Mailing Address - Fax:
Practice Address - Street 1:10420 PLANO RD STE 113
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5329
Practice Address - Country:US
Practice Address - Phone:214-325-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX72626OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES