Provider Demographics
NPI:1083759336
Name:PERRONE-MCGOVERN, KRISTIN (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PERRONE-MCGOVERN
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT OF COUNSELING PSYCHOLOGY TC 622
Mailing Address - Street 2:BALL STATE UNIVERSITY
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47306-1099
Mailing Address - Country:US
Mailing Address - Phone:317-441-6687
Mailing Address - Fax:
Practice Address - Street 1:100 N TILLOTSON AVE
Practice Address - Street 2:NEUROBEHAVIORAL HEALTH
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3987
Practice Address - Country:US
Practice Address - Phone:317-441-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041593A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist