Provider Demographics
NPI:1144639865
Name:MANNON, KRISTI ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:ANN
Last Name:MANNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5009 THOMPSON TER STE 103
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5850
Mailing Address - Country:US
Mailing Address - Phone:817-618-3705
Mailing Address - Fax:817-668-6013
Practice Address - Street 1:5009 THOMPSON TER STE 103
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5850
Practice Address - Country:US
Practice Address - Phone:817-618-3705
Practice Address - Fax:817-668-6013
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical