Provider Demographics
NPI:1558760645
Name:KRISTIN MCCONNELL LLC
Entity Type:Organization
Organization Name:KRISTIN MCCONNELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:614-804-4806
Mailing Address - Street 1:1222 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1737
Mailing Address - Country:US
Mailing Address - Phone:614-804-4806
Mailing Address - Fax:
Practice Address - Street 1:438 S MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-5541
Practice Address - Country:US
Practice Address - Phone:614-804-4806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty