Provider Demographics
NPI:1902678360
Name:AUDREY E KTEILY PHD PLLC
Entity Type:Organization
Organization Name:AUDREY E KTEILY PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KTEILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-304-0700
Mailing Address - Street 1:684 S DENTON TAP RD # 110
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4542
Mailing Address - Country:US
Mailing Address - Phone:972-304-0700
Mailing Address - Fax:972-692-5844
Practice Address - Street 1:684 S DENTON TAP RD # 110
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4542
Practice Address - Country:US
Practice Address - Phone:972-304-0700
Practice Address - Fax:972-692-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty