Provider Demographics
NPI:1811410210
Name:KRISTINA L EDLER, LLC
Entity Type:Organization
Organization Name:KRISTINA L EDLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDLER
Authorized Official - Suffix:
Authorized Official - Credentials:LISWS
Authorized Official - Phone:614-209-1234
Mailing Address - Street 1:2718 MOUNT HOLYOKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3425
Mailing Address - Country:US
Mailing Address - Phone:614-209-1234
Mailing Address - Fax:
Practice Address - Street 1:3040 RIVERSIDE DR STE 206
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43221-2550
Practice Address - Country:US
Practice Address - Phone:614-209-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1451189261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health