Provider Demographics
NPI:1821566472
Name:STEPHENS-HOLLAND, KRYSTAL L (MA, LMT,TS)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:L
Last Name:STEPHENS-HOLLAND
Suffix:
Gender:F
Credentials:MA, LMT,TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 WILLOW CHASE BLVD APT 1433
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6811
Mailing Address - Country:US
Mailing Address - Phone:832-654-7019
Mailing Address - Fax:
Practice Address - Street 1:7700 WILLOW CHASE BLVD APT 1433
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6811
Practice Address - Country:US
Practice Address - Phone:832-654-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT121192225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty