Provider Demographics
NPI:1457042152
Name:KOULABOUTH, KRISTIN EUGENIA BOLTON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:EUGENIA BOLTON
Last Name:KOULABOUTH
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 1:1603 HIGHLAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-6837
Mailing Address - Country:US
Mailing Address - Phone:817-266-2675
Mailing Address - Fax:
Practice Address - Street 1:8408 DAVIS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182
Practice Address - Country:US
Practice Address - Phone:817-765-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1524538101YS0200X
TX85075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool