Healthcare Provider Details

I. General information

NPI: 1477198521
Provider Name (Legal Business Name): KRISTIN THOMPSON COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
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

1709 BRISCOE DR
LANTANA TX
76226-2590
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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN THOMPSON
Title or Position: SOLE MEMBER
Credential: LCSW
Phone: 512-468-9619