Healthcare Provider Details

I. General information

NPI: 1093272692
Provider Name (Legal Business Name): KRYSTEN OHLIG MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 MCDERMOTT RD STE 210
PLANO TX
75024-7742
US

IV. Provider business mailing address

5200 MCDERMOTT RD STE 210
PLANO TX
75024-7742
US

V. Phone/Fax

Practice location:
  • Phone: 469-431-4460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75373
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: