Provider Demographics
NPI:1215293238
Name:PADDACK, KRISTY (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:PADDACK
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 1:8308 PARAGON DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-7220
Mailing Address - Country:US
Mailing Address - Phone:806-206-8583
Mailing Address - Fax:
Practice Address - Street 1:4300 TECKLA BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5494
Practice Address - Country:US
Practice Address - Phone:806-206-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional