Provider Demographics
NPI:1245481969
Name:THOMPSON, KRISTIN LEE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 KAITLYN CT
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1370
Mailing Address - Country:US
Mailing Address - Phone:512-468-9619
Mailing Address - Fax:
Practice Address - Street 1:1428 W HEBRON PKWY
Practice Address - Street 2:STE 135
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6345
Practice Address - Country:US
Practice Address - Phone:512-468-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51863104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX51863OtherTEXAS STATE BOARD OF SOCIAL WORK EXAMINERS