=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194686238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARISA KERWIN M.ED, LPC-ASSOCIATE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 S STONEBRIDGE DR
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-7899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-920-5236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1104 BISMARCK LN
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94502-6936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-539-1805
-----------------------------------------------------
Fax | 915-539-1805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 100096
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------