Provider Demographics
NPI:1336521210
Name:DEVILLIER, KRISTINA (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:DEVILLIER
Suffix:
Gender:F
Credentials:MED, LPC
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 401
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-0401
Mailing Address - Country:US
Mailing Address - Phone:409-718-5418
Mailing Address - Fax:
Practice Address - Street 1:520 S TWIN CITY HWY STE 106
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627
Practice Address - Country:US
Practice Address - Phone:409-718-0800
Practice Address - Fax:888-295-3022
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional