Kalos Counseling and Diagnostics, PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

63792 Issued in TX

Legal business name

KALOS COUNSELING AND DIAGNOSTICS, PLLC

Practice address

1091 N Main St
Vidor, TX 77662-4339

Phone

(409) 769-8910

Fax

(409) 769-8914

NPI assigned

Dec 9, 2009

Last updated

Dec 9, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Benjamin Scott Odom, M.ED., LPC

Title

Manager

Phone

(409) 769-8910

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260316800000",
    "number": "1376872986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 624",
            "city": "VIDOR",
            "state": "TX",
            "postal_code": "776700624",
            "telephone_number": "409-769-8910",
            "fax_number": "409-769-8914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1091 N MAIN ST",
            "city": "VIDOR",
            "state": "TX",
            "postal_code": "776624339",
            "telephone_number": "409-769-8910",
            "fax_number": "409-769-8914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALOS COUNSELING AND DIAGNOSTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-09",
        "last_updated": "2009-12-09",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "409-769-8910",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.ED., LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "63792",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "62334",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Vidor, TX
• Providers in Vidor, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.