Healthcare Provider Details

I. General information

NPI: 1871867176
Provider Name (Legal Business Name): KRISTY M DONALDSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2012
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 HILLCREST DR STE 8
WACO TX
76708-3144
US

IV. Provider business mailing address

3500 HILLCREST DR STE 8
WACO TX
76708-3144
US

V. Phone/Fax

Practice location:
  • Phone: 254-262-3506
  • Fax: 254-262-3506
Mailing address:
  • Phone: 254-262-3506
  • Fax: 254-262-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number63523
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number63523
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: