Provider Demographics
NPI:1558189985
Name:CLEMENTS, KRISTIN NICOLE (MS, LPC-A)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICOLE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MS, LPC-A
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:NICOLE
Other - Last Name:HAYTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 HUECO VALLEY DR APT 2405
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5432
Mailing Address - Country:US
Mailing Address - Phone:956-379-0848
Mailing Address - Fax:
Practice Address - Street 1:1700 CURIE DR STE 2100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2981
Practice Address - Country:US
Practice Address - Phone:915-200-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional