Provider Demographics
NPI:1457928723
Name:THORNTON, KRYSTAL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:
Last Name:THORNTON
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 1:4430 JAMIE WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75236-4237
Mailing Address - Country:US
Mailing Address - Phone:214-709-6590
Mailing Address - Fax:
Practice Address - Street 1:10288 E NORTHWEST HWY
Practice Address - Street 2:#1058
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4237
Practice Address - Country:US
Practice Address - Phone:469-358-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty