Healthcare Provider Details

I. General information

NPI: 1093244147
Provider Name (Legal Business Name): KRISTY M DONALDSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2017
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
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 Code101YP2500X
TaxonomyProfessional Counselor
License Number63523
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number63523
License Number StateTX

VIII. Authorized Official

Name: BARBARA CARTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 214-725-8062