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General NPI Number Information
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NPI Number | 1093244147
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Entity Type | Organization
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Legal Business Name | KRISTY M DONALDSON
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Dates
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Enumeration Date | 06/11/2017
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 3500 HILLCREST DR STE 8
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City | WACO
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State | TX
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Zip | 76708-3144
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Country | US
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Telephone | 254-262-3506
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Fax | 254-262-3506
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Provider Business Mailing Address
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Address Line | 3500 HILLCREST DR STE 8
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City | WACO
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State | TX
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Zip | 76708-3144
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Country | US
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Telephone | 254-262-3506
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Fax | 254-262-3506
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | BARBARA CARTER
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Credential |
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Telephone | 214-725-8062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 63523
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 63523
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License Number State | TX
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