Provider Demographics
NPI:1528413994
Name:ADAMEK, KERRY GLEN (LPC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:GLEN
Last Name:ADAMEK
Suffix:
Gender:M
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:PO BOX 396
Mailing Address - Street 2:500 E. CRAWFORD
Mailing Address - City:TALCO
Mailing Address - State:TX
Mailing Address - Zip Code:75487-0396
Mailing Address - Country:US
Mailing Address - Phone:903-563-0270
Mailing Address - Fax:
Practice Address - Street 1:500 E. CRAWFORD
Practice Address - Street 2:
Practice Address - City:TALCO
Practice Address - State:TX
Practice Address - Zip Code:75487
Practice Address - Country:US
Practice Address - Phone:903-563-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional