Provider Demographics
NPI:1720564768
Name:BILLUPS, KURT (LPC)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:BILLUPS
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 1:4217 ALTAMESA BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-5401
Mailing Address - Country:US
Mailing Address - Phone:972-430-6706
Mailing Address - Fax:972-833-1006
Practice Address - Street 1:4217 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5401
Practice Address - Country:US
Practice Address - Phone:972-430-6706
Practice Address - Fax:972-833-1006
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14139778101YP2500X
TX13169774101YA0400X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398311601Medicaid