Provider Demographics
NPI:1881833986
Name:DISCALA, KRISTINE LOUISE (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:LOUISE
Last Name:DISCALA
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12948 COLDWATER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8016
Mailing Address - Country:US
Mailing Address - Phone:260-373-0880
Mailing Address - Fax:260-373-0881
Practice Address - Street 1:12948 COLDWATER RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8016
Practice Address - Country:US
Practice Address - Phone:260-373-0880
Practice Address - Fax:260-373-0881
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002051A101YM0800X
IN20042426A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health