Provider Demographics
NPI:1174267926
Name:JOUBERT-HARDY, KRYSTEN ALICIA (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:ALICIA
Last Name:JOUBERT-HARDY
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 1:1412 ADDISON DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8760
Mailing Address - Country:US
Mailing Address - Phone:931-237-4922
Mailing Address - Fax:
Practice Address - Street 1:1820 MEMORIAL DR STE 203
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4693
Practice Address - Country:US
Practice Address - Phone:931-249-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health