MEDICARE: KRISTIN LYNNE DEAN 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
1	1041C0700X	Clinical Social Worker	56528	TX
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861262834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN LYNNE DEAN LCSW

Provider Business Mailing Address
First Line	:	1211 S MAIN ST STE 300-A
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-0818
Country	:	US
Telephone Number	:	817-851-8609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 S MAIN ST STE 300-A
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-0818
Country	:	US
Telephone Number	:	817-851-8609
Fax Number	:

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

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	05/15/2025

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