Kalos Counseling and Diagnostics, PLLC
Organization Active NPI Professional Counselor · Vidor, TX
NPI 1376872986 · NPPES record last updated Dec 9, 2009
Key facts
- NPI
- 1376872986
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 63792 (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
- Organization subpart
- No
Authorized official
- Name
- Mr. Benjamin Scott Odom, M.ED., LPC
- Title
- Manager
- Phone
- (409) 769-8910
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260618004443 | TX | Part B Supplier - Clinic/Group Practice | 5294207346 | Practice locations: Vidor, TX |
National Provider Directory
Locations
1091 N Main St
Vidor, TX 77662
Phone (409) 769-8910
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | 63792 | TX | Yes |
| Professional Counselor |
101YP2500X | 62334 | TX |
Addresses
Primary practice location
1091 N Main St
Vidor, TX 77662-4339
Mailing address
PO Box 624
Vidor, TX 77670-0624
Phone (409) 769-8910
Other providers in Vidor, TX
- Tory Lynn Hoecker
- Leann Holloway
- Janet Rose Hooper
- Hannah Elise Huff
- Syed Muhammad Ali Ahmed Jilani
- Matilda Denise Kelley
- Kelley'S Karing Touch, LLC
- Kids Therapy Set, LLC
- Melvin Kohn
- Jennie Lam
All providers in Vidor, TX · Professional Counselor in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.