Provider Demographics
NPI:1760926877
Name:KIRKLEY, HOWARD BRENT (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:BRENT
Last Name:KIRKLEY
Suffix:
Gender:M
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 1:5401 HOLLYTREE DR APT 1202
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3477
Mailing Address - Country:US
Mailing Address - Phone:903-630-0423
Mailing Address - Fax:
Practice Address - Street 1:3800 PALUXY DR STE 240
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1667
Practice Address - Country:US
Practice Address - Phone:903-283-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11477101YP2500X
TX3380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist