Basic Information
| Provider Information | |||||||||
| NPI: | 1457719221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PROCHNOW | ||||||||
| FirstName: | KIERSTEN | ||||||||
| MiddleName: | LIGHT | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LIGHT | ||||||||
| OtherFirstName: | KIERSTEN | ||||||||
| OtherMiddleName: | CLARE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3750 E. PALM VALLEY BLVD., UNIT 112 | ||||||||
| Address2: | |||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186558265 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 TAYLOR ST. | ||||||||
| Address2: | |||||||||
| City: | HUTTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183980945 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2016 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | PLC6588 | LA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.