Provider Demographics
NPI:1093060998
Name:KRISTY PADDACK COUNSELING PLLC
Entity Type:Organization
Organization Name:KRISTY PADDACK COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PADDACK
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:806-206-8583
Mailing Address - Street 1:8308 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-7220
Mailing Address - Country:US
Mailing Address - Phone:806-206-8583
Mailing Address - Fax:806-418-2691
Practice Address - Street 1:4300 TECKLA BLVD
Practice Address - Street 2:SUITE 3B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5494
Practice Address - Country:US
Practice Address - Phone:806-206-8583
Practice Address - Fax:806-418-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty