Provider Demographics
NPI:1598921850
Name:INDERMILL, KRISTEN LYN (MFT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYN
Last Name:INDERMILL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYN
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 S FORK WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2046
Mailing Address - Country:US
Mailing Address - Phone:805-260-5529
Mailing Address - Fax:
Practice Address - Street 1:110 S FORK WAY
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2046
Practice Address - Country:US
Practice Address - Phone:805-260-5529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor