Provider Demographics
NPI:1164838736
Name:SAVAGE, KALEASHA (MA)
Entity Type:Individual
Prefix:
First Name:KALEASHA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N MIDLAND DR STE 2910
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3385
Mailing Address - Country:US
Mailing Address - Phone:432-400-5026
Mailing Address - Fax:
Practice Address - Street 1:4400 N MIDLAND DR STE 2910
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3385
Practice Address - Country:US
Practice Address - Phone:432-400-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2024-03-04
Deactivation Date:2022-05-26
Deactivation Code:
Reactivation Date:2022-07-06
Provider Licenses
StateLicense IDTaxonomies
TX203991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist