Provider Demographics
NPI:1295480721
Name:STRUBLE, KRISTAL THI (MA)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:THI
Last Name:STRUBLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1135
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77353-1135
Mailing Address - Country:US
Mailing Address - Phone:209-620-2421
Mailing Address - Fax:
Practice Address - Street 1:994 VILLAGE SQUARE DR BLDG 6
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5293
Practice Address - Country:US
Practice Address - Phone:209-620-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120530106H00000X
CA8195101YP2500X
TX205544106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional