Provider Demographics
NPI:1851484455
Name:HOMANN, KALILA B (LPC)
Entity Type:Individual
Prefix:
First Name:KALILA
Middle Name:B
Last Name:HOMANN
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 1:1310 SOUTH 1ST STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN,
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-441-8334
Mailing Address - Fax:512-444-3931
Practice Address - Street 1:1310 SOUTH 1ST STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN,
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:512-441-8334
Practice Address - Fax:512-444-3931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0259871Medicaid