Healthcare Provider Details

I. General information

NPI: 1245481969
Provider Name (Legal Business Name): KRISTIN LEE THOMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 W HEBRON PKWY STE 135
CARROLLTON TX
75010-6345
US

IV. Provider business mailing address

9220 KAITLYN CT
LANTANA TX
76226-1370
US

V. Phone/Fax

Practice location:
  • Phone: 512-468-9619
  • Fax:
Mailing address:
  • Phone: 512-468-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number51863
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: