Provider Demographics
NPI:1578770293
Name:DEAN, KRISTY WILEY (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:WILEY
Last Name:DEAN
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11114 QUAIL RISE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3334
Mailing Address - Country:US
Mailing Address - Phone:210-355-2352
Mailing Address - Fax:210-558-7037
Practice Address - Street 1:802 AUGUSTA ST
Practice Address - Street 2:SUITE #203
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1643
Practice Address - Country:US
Practice Address - Phone:210-226-6360
Practice Address - Fax:210-558-7037
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14282101YP2500X
TX004795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist