Provider Demographics
NPI:1871252031
Name:WESSON, KIAH M (LPC)
Entity Type:Individual
Prefix:
First Name:KIAH
Middle Name:M
Last Name:WESSON
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 1:424 PERSIMMON DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2901
Mailing Address - Country:US
Mailing Address - Phone:214-537-1238
Mailing Address - Fax:
Practice Address - Street 1:14800 QUORUM DR STE 261
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7073
Practice Address - Country:US
Practice Address - Phone:214-859-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health