Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 68835 | TX |
N | 101YP1600X | Pastoral Counselor | 68835 | TX |
Y | 101YP2500X | Professional Counselor | 68835 | TX |
NPI | 1194073247 |
---|---|
Provider Name | Miss Kristen Michelle Elliott |
First Address | Burleson, TX 76028-3947 |
Second Address | Burleson, TX 76028-3947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 21/08/2012 |