Provider Demographics
NPI:1336300656
Name:WINBUSH, KRISTIN JANEE' (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JANEE'
Last Name:WINBUSH
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 1:5909 SHELBY OAKS DR STE 117
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7318
Mailing Address - Country:US
Mailing Address - Phone:901-361-2330
Mailing Address - Fax:
Practice Address - Street 1:5909 SHELBY OAKS DR STE 117
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7318
Practice Address - Country:US
Practice Address - Phone:901-361-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty