Provider Demographics
NPI:1679564314
Name:KEMP, VIVIAN S (LPC)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:S
Last Name:KEMP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 TROUP HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2356
Mailing Address - Country:US
Mailing Address - Phone:903-581-6300
Mailing Address - Fax:903-581-0235
Practice Address - Street 1:4801 TROUP HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2356
Practice Address - Country:US
Practice Address - Phone:903-581-6300
Practice Address - Fax:903-581-0235
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional