Provider Demographics
NPI:1730277492
Name:YEAGLEY, KRISTIE S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:S
Last Name:YEAGLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 RUSTIC HILLS LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-6412
Mailing Address - Country:US
Mailing Address - Phone:713-417-7935
Mailing Address - Fax:
Practice Address - Street 1:13910 RUSTIC HILLS LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6412
Practice Address - Country:US
Practice Address - Phone:713-417-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D9654Medicare PIN