Provider Demographics
NPI:1467156109
Name:DEMOREST, KRISTIN (RBT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DEMOREST
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3741
Mailing Address - Country:US
Mailing Address - Phone:615-331-1141
Mailing Address - Fax:
Practice Address - Street 1:3808 PARK AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-3741
Practice Address - Country:US
Practice Address - Phone:615-331-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician