Provider Demographics
NPI:1760266266
Name:VERACRUZ, KELLY LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:VERACRUZ
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 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-664-0145
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:213 S DUVAL ST
Practice Address - Street 2:
Practice Address - City:MATHIS
Practice Address - State:TX
Practice Address - Zip Code:78368-2613
Practice Address - Country:US
Practice Address - Phone:361-547-4121
Practice Address - Fax:361-384-4254
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional