Provider Demographics
NPI:1558605360
Name:TALBERT, KRISTINA LYNNE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:LYNNE
Last Name:TALBERT
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1206 W SOUTH JORDAN PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5519
Mailing Address - Country:US
Mailing Address - Phone:801-302-3801
Mailing Address - Fax:801-302-7248
Practice Address - Street 1:1206 W SOUTH JORDAN PKWY STE D
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5519
Practice Address - Country:US
Practice Address - Phone:801-302-3801
Practice Address - Fax:801-302-7248
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8788507-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical