Provider Demographics
NPI:1467732354
Name:WOLFE, KRISTIN LOUISE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LOUISE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:LOUISE
Other - Last Name:FOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:216 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2431
Mailing Address - Country:US
Mailing Address - Phone:281-332-5100
Mailing Address - Fax:281-332-5155
Practice Address - Street 1:216 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2431
Practice Address - Country:US
Practice Address - Phone:281-332-5100
Practice Address - Fax:281-332-5155
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1414103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1414OtherTLMLP LICENSE