Provider Demographics
NPI:1598775983
Name:STILES, KATHLEEN ELLIS (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELLIS
Last Name:STILES
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 SAVANNAH TRL
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-8210
Mailing Address - Country:US
Mailing Address - Phone:940-382-4566
Mailing Address - Fax:
Practice Address - Street 1:522 S EDMONDS LN
Practice Address - Street 2:SUITE 207
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3524
Practice Address - Country:US
Practice Address - Phone:972-436-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2384101YM0800X
TX1705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist