Provider Demographics
NPI:1275629610
Name:CORBIN-KEITH, KRISTA ALISE (MAT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:ALISE
Last Name:CORBIN-KEITH
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 N 22ND STREET
Mailing Address - Street 2:MENTAL HEALTH CARE INC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610
Mailing Address - Country:US
Mailing Address - Phone:813-272-2878
Mailing Address - Fax:813-272-3766
Practice Address - Street 1:1108 TIBURON DR
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5066
Practice Address - Country:US
Practice Address - Phone:813-508-8528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762450600Medicaid