Provider Demographics
NPI:1154470441
Name:NEWMAN, KRISTEN DURHAM (LPC,MHSP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DURHAM
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LPC,MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2623
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-2623
Mailing Address - Country:US
Mailing Address - Phone:615-449-9611
Mailing Address - Fax:615-453-7051
Practice Address - Street 1:440 PARK AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3631
Practice Address - Country:US
Practice Address - Phone:615-449-9611
Practice Address - Fax:615-453-7051
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional