Provider Demographics
NPI:1881222313
Name:KRELL, CHRISTOPHER GABRIEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:GABRIEL
Last Name:KRELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SE MACON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-2986
Mailing Address - Country:US
Mailing Address - Phone:850-464-3725
Mailing Address - Fax:
Practice Address - Street 1:133 SE MACON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2986
Practice Address - Country:US
Practice Address - Phone:850-464-3725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional