Provider Demographics
NPI:1104309350
Name:ZILLS, KRISTINA NICOLE (MA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:NICOLE
Last Name:ZILLS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:NICOLE
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:26205 OAK RIDGE DR. SUITE 103
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:832-534-3993
Mailing Address - Fax:832-543-8665
Practice Address - Street 1:26205 OAK RIDGE DR. SUITE 103
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:832-534-3993
Practice Address - Fax:832-543-8665
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35028103TB0200X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical