Provider Demographics
NPI:1083730527
Name:OTTIS, KRISTI (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:OTTIS
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 INDIAN SUMMER TRL
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5051
Mailing Address - Country:US
Mailing Address - Phone:479-200-6034
Mailing Address - Fax:281-819-7845
Practice Address - Street 1:3526 E FM 528 RD
Practice Address - Street 2:SUITE 208
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5014
Practice Address - Country:US
Practice Address - Phone:479-200-6034
Practice Address - Fax:281-819-7845
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI-216419601Medicaid
MO497581405Medicaid