Provider Demographics
NPI:1033514872
Name:KLS COUNSELING & CONSULTING SERVICES
Entity Type:Organization
Organization Name:KLS COUNSELING & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:716-400-8301
Mailing Address - Street 1:1218 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3617
Mailing Address - Country:US
Mailing Address - Phone:716-400-8301
Mailing Address - Fax:972-572-1069
Practice Address - Street 1:214 S MAIN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4700
Practice Address - Country:US
Practice Address - Phone:469-407-0381
Practice Address - Fax:972-572-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36677103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty