Provider Demographics
NPI:1356680797
Name:KRISTI HOUSE
Entity Type:Organization
Organization Name:KRISTI HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DERONETH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-249-0521
Mailing Address - Street 1:18441 NW 2ND AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4517
Mailing Address - Country:US
Mailing Address - Phone:305-249-0521
Mailing Address - Fax:
Practice Address - Street 1:18441 NW 2ND AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4517
Practice Address - Country:US
Practice Address - Phone:305-249-0521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11065251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health