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NPI Code Detail

MEDICARE: KRISTYN D CARRILLO LCSW

MEDICARE:   KRISTYN D CARRILLO  LCSW
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
11041C0700XClinical Social Worker62822TX

General Provider Information

NPI Number : 1487291852
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTYN D CARRILLO LCSW
Provider Business Mailing Address
First Line : 6314 PINYON TRAIL DR
Second Line :
City : SPRING
State : TX
Zip : 77389-4298
Country : US
Telephone Number : 202-360-3428
Fax Number :
Provider Business Practice Location Address
First Line : 6314 PINYON TRAIL DR
Second Line :
City : SPRING
State : TX
Zip : 77389-4298
Country : US
Telephone Number : 202-360-3428
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2019
Last Update Date : 12/04/2019

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Directions to “ KRISTYN D CARRILLO LCSW” Practice Location

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