Provider Demographics
NPI:1770862898
Name:BERRY, KRISTINA NOBLE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:NOBLE
Last Name:BERRY
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 1:1103 FORTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-1831
Mailing Address - Country:US
Mailing Address - Phone:850-769-6188
Mailing Address - Fax:
Practice Address - Street 1:1103 FORTUNE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1831
Practice Address - Country:US
Practice Address - Phone:850-769-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health