Provider Demographics
NPI:1144387689
Name:BARRETT, KRISTINA MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:BARRETT
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 1:230 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3420
Mailing Address - Country:US
Mailing Address - Phone:502-817-4473
Mailing Address - Fax:
Practice Address - Street 1:230 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3420
Practice Address - Country:US
Practice Address - Phone:502-817-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004210A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health