Provider Demographics
NPI:1386023380
Name:MCNEILL, KRISTEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SANGUINET ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5355
Mailing Address - Country:US
Mailing Address - Phone:817-255-2652
Mailing Address - Fax:817-255-2657
Practice Address - Street 1:3200 SANGUINET ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5355
Practice Address - Country:US
Practice Address - Phone:817-255-2652
Practice Address - Fax:817-255-2657
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68149101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX68149OtherLICENSE