Provider Demographics
NPI:1487200978
Name:DOVE, KRISTIN (T-LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DOVE
Suffix:
Gender:F
Credentials:T-LAC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:KS
Mailing Address - Zip Code:66512-0433
Mailing Address - Country:US
Mailing Address - Phone:785-250-5876
Mailing Address - Fax:
Practice Address - Street 1:4015 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3412
Practice Address - Country:US
Practice Address - Phone:785-266-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1659101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)