Provider Demographics
NPI:1487656492
Name:SORELLE, KRISTI (LCSW, BCD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:
Last Name:SORELLE
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LONDONDERRY DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7906
Mailing Address - Country:US
Mailing Address - Phone:254-772-8360
Mailing Address - Fax:254-776-5718
Practice Address - Street 1:305 LONDONDERRY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7906
Practice Address - Country:US
Practice Address - Phone:254-772-8360
Practice Address - Fax:254-776-5718
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX059621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S59QMedicare ID - Type Unspecified