Provider Demographics
NPI:1104029149
Name:ESPINOSA, KELLY K (LSSP, NCSP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:K
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:LSSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15902 PARKCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-4765
Mailing Address - Country:US
Mailing Address - Phone:832-692-3785
Mailing Address - Fax:
Practice Address - Street 1:PO BOX Z
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-2026
Practice Address - Country:US
Practice Address - Phone:281-229-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32986103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool