Basic Information
| Provider Information | |||||||||
| NPI: | 1265152664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | KHRISTIAN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 PROVIDENCE DR | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767072261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2543134200 | ||||||||
| FaxNumber: | 2543134549 | ||||||||
| Practice Location | |||||||||
| Address1: | 1911 N MARTIN LUTHER KING JR BLVD | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767041438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2543135000 | ||||||||
| FaxNumber: | 2543135099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2022 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 106025 | TX | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.