Provider Demographics
NPI:1710202908
Name:DEFOREST, KRISTIN MICHELE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MICHELE
Last Name:DEFOREST
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4640
Mailing Address - Country:US
Mailing Address - Phone:215-345-8638
Mailing Address - Fax:215-345-8334
Practice Address - Street 1:1740 S EASTON RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2885
Practice Address - Country:US
Practice Address - Phone:215-343-7720
Practice Address - Fax:215-343-2783
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12466101YM0800X
PA12465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101250539Medicaid