Basic Information
Provider Information
NPI: 1154871960
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCASLIN
FirstName: KRISTINE
MiddleName: LEA
NamePrefix: DR.
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 845347
Address2:  
City: DALLAS
State: TX
PostalCode: 752845347
CountryCode: US
TelephoneNumber: 2146450624
FaxNumber: 2146457709
Practice Location
Address1: 5200 HARRY HINES BLVD
Address2:  
City: DALLAS
State: TX
PostalCode: 75235
CountryCode: US
TelephoneNumber: 2145905536
FaxNumber: 2145905731
Other Information
ProviderEnumerationDate: 10/05/2016
LastUpdateDate: 07/27/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X37387TXY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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