Provider Demographics
NPI:1548727167
Name:TELGER, KATHLEEN A
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:TELGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 WACO WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-3502
Mailing Address - Country:US
Mailing Address - Phone:817-313-5634
Mailing Address - Fax:
Practice Address - Street 1:2501 PARKVIEW DR STE 190
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5824
Practice Address - Country:US
Practice Address - Phone:817-313-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional