Provider Demographics
NPI:1497179949
Name:BOSON, KENYA (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:BOSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80233
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78708-0233
Mailing Address - Country:US
Mailing Address - Phone:512-318-2503
Mailing Address - Fax:
Practice Address - Street 1:1106 CLAYTON LN
Practice Address - Street 2:STE. 500W
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1066
Practice Address - Country:US
Practice Address - Phone:512-318-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67084101Y00000X, 101YM0800X, 101YS0200X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool