Provider Demographics
NPI:1194226126
Name:CAIN, KRISTEN LASHAWN (LSSP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LASHAWN
Last Name:CAIN
Suffix:
Gender:F
Credentials:LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 JENNIFER TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3297
Mailing Address - Country:US
Mailing Address - Phone:214-282-4947
Mailing Address - Fax:
Practice Address - Street 1:635 JENNIFER TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3297
Practice Address - Country:US
Practice Address - Phone:214-282-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
36411103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool