Provider Demographics
NPI:1336337260
Name:BADE, MARY KRISTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KRISTIN
Last Name:BADE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BADE
Other - Last Name:ANDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:BLDG. C, STE 130
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6574
Mailing Address - Country:US
Mailing Address - Phone:512-567-5454
Mailing Address - Fax:512-306-9234
Practice Address - Street 1:1301 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BLDG C, STE. 130
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6574
Practice Address - Country:US
Practice Address - Phone:512-567-5454
Practice Address - Fax:512-306-9234
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33558103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling