Provider Demographics
NPI:1588080477
Name:WARREN, KRISTIN (LPC, LMFT, LCDC,)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:LPC, LMFT, LCDC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 SAINT JOSEPH ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6507
Mailing Address - Country:US
Mailing Address - Phone:214-702-1279
Mailing Address - Fax:
Practice Address - Street 1:1333 SAINT JOSEPH ST UNIT 9
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6507
Practice Address - Country:US
Practice Address - Phone:214-702-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-15
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12072101YA0400X
TX201782106H00000X
68600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist