MEDICARE: MISS KRISTEN MICHELLE ELLIOTT HEPLER MA, LPC, BCN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	68835	TX
2	101YM0800X	Mental Health Counselor	68835	TX

General Provider Information

NPI Number	:	1194073247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KRISTEN MICHELLE ELLIOTT HEPLER MA, LPC, BCN

Provider Business Mailing Address
First Line	:	5900 BALCONES DR # 21819
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4257
Country	:	US
Telephone Number	:	817-856-2783
Fax Number	:

Provider Business Practice Location Address
First Line	:	4744 KILPATRICK AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7228
Country	:	US
Telephone Number	:	817-856-2783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	10/17/2024

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