Provider Demographics
NPI:1457719221
Name:PROCHNOW, KIERSTEN LIGHT (LPC)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:LIGHT
Last Name:PROCHNOW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:CLARE
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3750 E. PALM VALLEY BLVD., UNIT 112
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665
Mailing Address - Country:US
Mailing Address - Phone:318-655-8265
Mailing Address - Fax:
Practice Address - Street 1:101 TAYLOR ST.
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634
Practice Address - Country:US
Practice Address - Phone:318-398-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC6588101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor