Provider Demographics
NPI:1972034445
Name:BULL-FREEMAN, KRISTIN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BULL-FREEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:BULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2670 WOODMAN CENTER CT
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1477
Mailing Address - Country:US
Mailing Address - Phone:314-795-0431
Mailing Address - Fax:
Practice Address - Street 1:2670 WOODMAN CENTER CT
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1477
Practice Address - Country:US
Practice Address - Phone:314-795-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-25
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200288101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor