Provider Demographics
NPI:1700415213
Name:SHENE, KRISTY MARIE (CAPRC II-MH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:MARIE
Last Name:SHENE
Suffix:
Gender:F
Credentials:CAPRC II-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 N MERIDIAN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4674
Mailing Address - Country:US
Mailing Address - Phone:317-964-0450
Mailing Address - Fax:317-964-0452
Practice Address - Street 1:3351 N MERIDIAN ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4674
Practice Address - Country:US
Practice Address - Phone:317-964-0450
Practice Address - Fax:317-964-0452
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist