Provider Demographics
NPI:1942334834
Name:KOONTZ, KRISTINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-1208
Mailing Address - Country:US
Mailing Address - Phone:717-232-7509
Mailing Address - Fax:717-635-2560
Practice Address - Street 1:124 PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1208
Practice Address - Country:US
Practice Address - Phone:717-232-7509
Practice Address - Fax:717-635-2560
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical