MEDICARE: MS. KRYSTAL MCCLENDON 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	101YM0800X	Mental Health Counselor	82603	TX

General Provider Information

NPI Number	:	1457928723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRYSTAL MCCLENDON LPC

Provider Business Mailing Address
First Line	:	4038 GARDEN GROVE RD
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-3883
Country	:	US
Telephone Number	:	214-709-6590
Fax Number	:

Provider Business Practice Location Address
First Line	:	10288 E NORTHWEST HWY
Second Line	:	#1058
City	:	DALLAS
State	:	TX
Zip	:	75238-4237
Country	:	US
Telephone Number	:	469-358-2437
Fax Number	:

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

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	02/27/2026

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