Provider Demographics
NPI:1619444346
Name:HARRY, KIANDRA (LPC)
Entity type:Individual
Prefix:
First Name:KIANDRA
Middle Name:
Last Name:HARRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4364 WESTERN CENTER BLVD
Mailing Address - Street 2:POB 2047
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137
Mailing Address - Country:US
Mailing Address - Phone:706-474-3424
Mailing Address - Fax:
Practice Address - Street 1:4364 WESTERN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-2043
Practice Address - Country:US
Practice Address - Phone:706-474-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TX90388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator