Provider Demographics
NPI:1417791484
Name:PACHECO, KRYSTINA (MA, LSSP)
Entity type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MA, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 YORKTOWN
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4724
Mailing Address - Country:US
Mailing Address - Phone:830-734-4782
Mailing Address - Fax:
Practice Address - Street 1:217 YORKTOWN
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4724
Practice Address - Country:US
Practice Address - Phone:830-734-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71420103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool