Provider Demographics
NPI:1487291852
Name:CARRILLO, KRISTYN D (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:D
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 PINYON TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4298
Mailing Address - Country:US
Mailing Address - Phone:202-360-3428
Mailing Address - Fax:
Practice Address - Street 1:6314 PINYON TRAIL DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-4298
Practice Address - Country:US
Practice Address - Phone:202-360-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical