Healthcare Provider Details

I. General information

NPI: 1265152664
Provider Name (Legal Business Name): KHRISTIAN HOWARD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 N MARTIN LUTHER KING JR BLVD
WACO TX
76704-1438
US

IV. Provider business mailing address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

V. Phone/Fax

Practice location:
  • Phone: 254-313-5000
  • Fax: 254-313-5099
Mailing address:
  • Phone: 254-313-4200
  • Fax: 254-313-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: