Healthcare Provider Details

I. General information

NPI: 1518129089
Provider Name (Legal Business Name): KRISTIN H KROLL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN HUNTER PHD

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date: 07/18/2024
Reactivation Date: 09/04/2024

III. Provider practice location address

403 GRACIOSA CV
AUSTIN TX
78746-6442
US

IV. Provider business mailing address

403 GRACIOSA CV
AUSTIN TX
78746-6442
US

V. Phone/Fax

Practice location:
  • Phone: 512-240-2633
  • Fax:
Mailing address:
  • Phone: 512-240-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number40314
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number40314
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: