Provider Demographics
NPI:1013309483
Name:TUBBS, KRISTEN WELLMAN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:WELLMAN
Last Name:TUBBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 FICKEY RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-8364
Mailing Address - Country:US
Mailing Address - Phone:979-820-1191
Mailing Address - Fax:
Practice Address - Street 1:1770 FICKEY RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-8364
Practice Address - Country:US
Practice Address - Phone:979-820-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional