Provider Demographics
NPI:1710555214
Name:BILLARD, KRISTA A (LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:A
Last Name:BILLARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 DEEPWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249-2145
Mailing Address - Country:US
Mailing Address - Phone:860-416-5711
Mailing Address - Fax:
Practice Address - Street 1:1244 STORRS RD
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2200
Practice Address - Country:US
Practice Address - Phone:860-450-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2605106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist