Provider Demographics
NPI:1932646403
Name:PRIAL, KATHLEEN (LPC, LCDC, LMFT-A)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PRIAL
Suffix:
Gender:F
Credentials:LPC, LCDC, LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 MORRIS AVE APT 4350
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6672
Mailing Address - Country:US
Mailing Address - Phone:516-456-1032
Mailing Address - Fax:
Practice Address - Street 1:5601 DEMOCRACY DR STE 135
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3672
Practice Address - Country:US
Practice Address - Phone:214-478-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12613101YA0400X
TX73080101YP2500X
TX202331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist