Provider Demographics
NPI:1477922490
Name:WATSON, KRISTI (MS LCADC, CCTP, BIP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MS LCADC, CCTP, BIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 INDIAN SPRINGS TRCE
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8359
Mailing Address - Country:US
Mailing Address - Phone:502-827-9797
Mailing Address - Fax:
Practice Address - Street 1:1000 E JOHN ROWAN BLVD STE 107
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-331-6002
Practice Address - Fax:502-331-6122
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYADCADC00223243101YA0400X
KY167170101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100459000Medicaid