Provider Demographics
NPI:1720365000
Name:HARTFORD, KRISTEN LEE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LEE
Last Name:HARTFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 S GARCON POINT RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-7313
Mailing Address - Country:US
Mailing Address - Phone:850-982-2899
Mailing Address - Fax:850-469-1081
Practice Address - Street 1:1150 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3308
Practice Address - Country:US
Practice Address - Phone:850-982-2899
Practice Address - Fax:850-469-1081
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10985101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor