Provider Demographics
NPI:1346952454
Name:QUINN, KRISTINA (MED, LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:MED, LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 MORGANS WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7097
Mailing Address - Country:US
Mailing Address - Phone:469-337-1520
Mailing Address - Fax:
Practice Address - Street 1:395 PITCHFORK TRL
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3260
Practice Address - Country:US
Practice Address - Phone:469-337-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88928101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor