Provider Demographics
NPI:1093853848
Name:ELLIOTT, KRISTI JAN (MS, LPC-S)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:JAN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MS, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 DAVID CROCKETT
Mailing Address - Street 2:
Mailing Address - City:FISCHER
Mailing Address - State:TX
Mailing Address - Zip Code:78623-2103
Mailing Address - Country:US
Mailing Address - Phone:281-844-3286
Mailing Address - Fax:
Practice Address - Street 1:29710 US HIGHWAY 281 N STE 205
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3289
Practice Address - Country:US
Practice Address - Phone:281-844-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186082705Medicaid