Provider Demographics
NPI:1245391598
Name:CHADD, KRISTY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:L
Last Name:CHADD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 BURNEY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-2801
Mailing Address - Country:US
Mailing Address - Phone:817-329-1815
Mailing Address - Fax:
Practice Address - Street 1:1340 N WHITE CHAPEL BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4303
Practice Address - Country:US
Practice Address - Phone:817-773-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30863103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist