Provider Demographics
NPI:1841574209
Name:LICHTENSTEIN, KYNA BASKIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KYNA
Middle Name:BASKIN
Last Name:LICHTENSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:KYNA
Other - Middle Name:COLLEEN
Other - Last Name:BASKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1531 WESTERN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-2356
Mailing Address - Country:US
Mailing Address - Phone:254-214-6060
Mailing Address - Fax:
Practice Address - Street 1:4555 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1814
Practice Address - Country:US
Practice Address - Phone:254-751-0400
Practice Address - Fax:254-776-0637
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51127171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2880353Medicaid