Basic Information
Provider Information | |||||||||
NPI: | 1427637636 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEYER | ||||||||
FirstName: | KRISTINA | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW, APHSW-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MEYER-ORTIZ | ||||||||
OtherFirstName: | KRISTINA | ||||||||
OtherMiddleName: | LEE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LCSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6800 PARK TEN BLVD STE 200S | ||||||||
Address2: |   | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782134293 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2102611060 | ||||||||
FaxNumber: | 2102611821 | ||||||||
Practice Location | |||||||||
Address1: | 6800 PARK TEN BLVD STE 200S | ||||||||
Address2: |   | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782134293 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2102611060 | ||||||||
FaxNumber: | 2102611821 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/05/2021 | ||||||||
LastUpdateDate: | 10/05/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/05/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 108665 | CA | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 187194 | AK | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW41669 | ID | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | BBHLCSWLIC55135 | MT | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C12160 | NM | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | L8354 | OR | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 106811 | TX | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.