Provider Demographics
NPI:1376872986
Name:KALOS COUNSELING AND DIAGNOSTICS, PLLC
Entity Type:Organization
Organization Name:KALOS COUNSELING AND DIAGNOSTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:409-769-8910
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77670-0624
Mailing Address - Country:US
Mailing Address - Phone:409-769-8910
Mailing Address - Fax:409-769-8914
Practice Address - Street 1:1091 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-4339
Practice Address - Country:US
Practice Address - Phone:409-769-8910
Practice Address - Fax:409-769-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63792101YP2500X
TX62334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty