Provider Demographics
NPI:1912537606
Name:KIDZ CONNECT COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:KIDZ CONNECT COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:360-396-0499
Mailing Address - Street 1:1213 CARLOS TRL
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-6728
Mailing Address - Country:US
Mailing Address - Phone:361-396-0499
Mailing Address - Fax:361-668-3033
Practice Address - Street 1:408 N TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-5039
Practice Address - Country:US
Practice Address - Phone:361-396-0499
Practice Address - Fax:361-668-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty