Provider Demographics
NPI:1891304796
Name:JOHNSON, KRISTY M (BAS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BAS
Other - Prefix:MRS
Other - First Name:KRISTY
Other - Middle Name:M
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3623 CHELLEN DR
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6623
Mailing Address - Country:US
Mailing Address - Phone:903-602-6597
Mailing Address - Fax:
Practice Address - Street 1:3623 CHELLEN DR
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-6623
Practice Address - Country:US
Practice Address - Phone:903-602-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health