Provider Demographics
NPI:1558010256
Name:KYRIE ELEISON COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:KYRIE ELEISON COUNSELING SERVICES PLLC
Other - Org Name:KE COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:FARRAH
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:409-203-2008
Mailing Address - Street 1:2727 BROADWAY AVE J
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550
Mailing Address - Country:US
Mailing Address - Phone:409-203-2008
Mailing Address - Fax:
Practice Address - Street 1:2727 BROADWAY AVE J
Practice Address - Street 2:SUITE 102
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-203-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty