Provider Demographics
NPI:1508037235
Name:BEYER, KRISTA LYNN (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:BEYER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17716 DOCTOR WALLING RD
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2402
Mailing Address - Country:US
Mailing Address - Phone:240-812-2925
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5471
Practice Address - Country:US
Practice Address - Phone:240-812-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical