Provider Demographics
NPI:1861262834
Name:DEAN, KRISTIN LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYNNE
Last Name:DEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LYNNE
Other - Last Name:CARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 S MAIN ST STE 300-A
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0818
Mailing Address - Country:US
Mailing Address - Phone:817-851-8609
Mailing Address - Fax:
Practice Address - Street 1:1211 S MAIN ST STE 300-A
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0818
Practice Address - Country:US
Practice Address - Phone:817-851-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565281041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical