MEDICARE: KRISSANDRA CHERRIA HAYNES LPC

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	81998	TX

General Provider Information

NPI Number	:	1245824457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISSANDRA CHERRIA HAYNES LPC

Provider Business Mailing Address
First Line	:	115 CRESTBROOK DR
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75087-7131
Country	:	US
Telephone Number	:	770-298-3558
Fax Number	:

Provider Business Practice Location Address
First Line	:	7290 VIRGINIA PKWY
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5740
Country	:	US
Telephone Number	:	469-808-1016
Fax Number	:

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

Provider Enumeration Date	:	02/28/2021
Last Update Date	:	02/28/2021

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Directions to “ KRISSANDRA CHERRIA HAYNES LPC” Practice Location

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