Provider Demographics
NPI:1467706499
Name:KALB-WELDY, KRYSTAL FAYE (LMHC, RPT)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:FAYE
Last Name:KALB-WELDY
Suffix:
Gender:F
Credentials:LMHC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 IRONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1864
Mailing Address - Country:US
Mailing Address - Phone:574-243-9370
Mailing Address - Fax:574-243-9375
Practice Address - Street 1:2106 IRONWOOD CIR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1864
Practice Address - Country:US
Practice Address - Phone:574-243-9370
Practice Address - Fax:574-243-9375
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002401A101YM0800X
VA0701005175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health