Organization Name: | KRIS FITZGERALD, LMHC, PLLC |
NPI Number: | 1205299161 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRISTEN T FITZGERALD (LICENSED MENTAL HEALTH COUNSELOR) |
Mailing Address: | 116 Brookshire Dr Lake Wales |
State: | FL US |
Postal Code: | 338987601 |
Phone Number: | 8632412785 |
Fax Number: | |
NPI Enumeration Date: | 03/29/2016 |
NPI Last Update Date: | 03/29/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 13651 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |