Provider Demographics
NPI:1174930267
Name:AUBRY, KELLY GARRETT (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:GARRETT
Last Name:AUBRY
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 1:170 BOTANA WAY
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3418
Mailing Address - Country:US
Mailing Address - Phone:361-774-5961
Mailing Address - Fax:
Practice Address - Street 1:170 BOTANA WAY
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3418
Practice Address - Country:US
Practice Address - Phone:361-774-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional