Healthcare Provider Details

I. General information

NPI: 1376454512
Provider Name (Legal Business Name): KRISTEN L MCCRARY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 FIVE POINTS DR
RUSSELL SPRINGS KY
42642-5725
US

IV. Provider business mailing address

230 FIVE POINTS DR
RUSSELL SPRINGS KY
42642-5725
US

V. Phone/Fax

Practice location:
  • Phone: 864-567-1251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number129722
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number129722
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: