Provider Demographics
NPI:1821566472
Name:HOLLAND, KRYSTAL (MA, LMT, CLT, CCT,)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MA, LMT, CLT, CCT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7676 HILLMONT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6400
Mailing Address - Country:US
Mailing Address - Phone:832-654-7019
Mailing Address - Fax:
Practice Address - Street 1:7700 WILLOW CHASE BLVD APT 1433
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6811
Practice Address - Country:US
Practice Address - Phone:832-654-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT121192225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty