Provider Demographics
NPI:1073254421
Name:KENT, MISTY GALE (LPC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:GALE
Last Name:KENT
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 1:1910 ODANIEL RD
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-2087
Mailing Address - Country:US
Mailing Address - Phone:210-264-0702
Mailing Address - Fax:
Practice Address - Street 1:634 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5725
Practice Address - Country:US
Practice Address - Phone:830-243-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83632101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor