Provider Demographics
NPI:1548376387
Name:NEELY, KIRLEEN (PHD, LPC-S)
Entity type:Individual
Prefix:DR
First Name:KIRLEEN
Middle Name:
Last Name:NEELY
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 BANDERA RD STE D
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4735
Mailing Address - Country:US
Mailing Address - Phone:210-523-4200
Mailing Address - Fax:
Practice Address - Street 1:11153 WESTWOOD LOOP STE 122
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6766
Practice Address - Country:US
Practice Address - Phone:210-414-8949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16484103TB0200X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096034601Medicaid