Provider Demographics
NPI:1255824397
Name:PAUL, KRISTEN ELIZABETH (LGMFT, LGPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:PAUL
Suffix:
Gender:F
Credentials:LGMFT, LGPC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH-PAUL
Other - Last Name:KALEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1303 GRAND CANOPY DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-6814
Mailing Address - Country:US
Mailing Address - Phone:443-734-7837
Mailing Address - Fax:
Practice Address - Street 1:2126 ESPEY CT STE B
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2425
Practice Address - Country:US
Practice Address - Phone:443-734-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11375101YP2500X
MDA02331224Z00000X
MDM05538225700000X
MDLGM798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist