Provider Demographics
NPI:1821669920
Name:POWELL-BYERLY, KESHIA (MED, LPC-A)
Entity Type:Individual
Prefix:MRS
First Name:KESHIA
Middle Name:
Last Name:POWELL-BYERLY
Suffix:
Gender:F
Credentials:MED, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 GRANTS LAKE BLVD STE 18311
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1255
Mailing Address - Country:US
Mailing Address - Phone:832-954-6595
Mailing Address - Fax:
Practice Address - Street 1:210 LAKE RD STE 700A
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4988
Practice Address - Country:US
Practice Address - Phone:979-285-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health