Provider Demographics
NPI:1235277674
Name:KERN, CECELIA A (LPC)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:A
Last Name:KERN
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 1:3012 SW 26TH AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109
Mailing Address - Country:US
Mailing Address - Phone:806-626-6991
Mailing Address - Fax:
Practice Address - Street 1:3012 SW 26TH AVE STE 700
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3110
Practice Address - Country:US
Practice Address - Phone:806-626-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180835401Medicaid
274LLCOtherBCBS OF TEXAS