Provider Demographics
NPI:1659316537
Name:ZENTNER, KELLY S (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:S
Last Name:ZENTNER
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 FM 2252 STE 15
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266
Mailing Address - Country:US
Mailing Address - Phone:210-833-1900
Mailing Address - Fax:210-281-5108
Practice Address - Street 1:19115 FM 2252 STE 15
Practice Address - Street 2:
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266
Practice Address - Country:US
Practice Address - Phone:210-833-1900
Practice Address - Fax:210-281-5108
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17764101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017LKOtherBCBS NUMBER
TX152081901Medicaid