Provider Demographics
NPI:1689363483
Name:NECKLES, KRISTYN (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:NECKLES
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 1:13 WESTFIELD PL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3853
Mailing Address - Country:US
Mailing Address - Phone:786-602-2810
Mailing Address - Fax:
Practice Address - Street 1:13 W STIMSON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2649
Practice Address - Country:US
Practice Address - Phone:740-562-6948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty