Provider Demographics
NPI:1871867176
Name:DONALDSON, KRISTY M (LPC)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:M
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 HILLCREST DR STE 8
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3144
Mailing Address - Country:US
Mailing Address - Phone:254-262-3506
Mailing Address - Fax:254-262-3506
Practice Address - Street 1:3500 HILLCREST DR STE 8
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3144
Practice Address - Country:US
Practice Address - Phone:254-262-3506
Practice Address - Fax:254-262-3506
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-04
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63523101YM0800X, 101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289672201Medicaid
TX289672205Medicaid