Healthcare Provider Details

I. General information

NPI: 1023861515
Provider Name (Legal Business Name): CRISSY CATES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COCOPA DR
LAKE KIOWA TX
76240-9281
US

IV. Provider business mailing address

105 COCOPA DR
LAKE KIOWA TX
76240-9281
US

V. Phone/Fax

Practice location:
  • Phone: 214-662-4812
  • Fax:
Mailing address:
  • Phone: 214-662-4812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number92031
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: