Provider Demographics
NPI:1134950124
Name:SELLERS, KRISTIN JANE (MS, LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JANE
Last Name:SELLERS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 N 14TH PL
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-3380
Mailing Address - Country:US
Mailing Address - Phone:806-549-5118
Mailing Address - Fax:
Practice Address - Street 1:1206 N 14TH PL
Practice Address - Street 2:
Practice Address - City:WOLFFORTH
Practice Address - State:TX
Practice Address - Zip Code:79382-3380
Practice Address - Country:US
Practice Address - Phone:806-549-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional