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General NPI Number Information
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NPI Number | 1427321314
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Entity Type | Individual
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Provider Name | KRISTY L LACKO PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 3800 S W S YOUNG DR STE 407
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City | KILLEEN
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State | TX
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Zip | 76542-3374
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Country | US
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Telephone | 254-252-3748
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Fax | 254-549-0086
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Provider Business Mailing Address
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Address Line | 2330 STANLEY RD SUITE C
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-2636
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 24531
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36749
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License Number State | TX
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