Provider Demographics
NPI:1992084131
Name:NOBLE-HARTZLER, KRYSTON JEAN (LCSW, LCAC)
Entity type:Individual
Prefix:MS
First Name:KRYSTON
Middle Name:JEAN
Last Name:NOBLE-HARTZLER
Suffix:
Gender:F
Credentials:LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3702
Mailing Address - Country:US
Mailing Address - Phone:574-533-6154
Mailing Address - Fax:574-534-3951
Practice Address - Street 1:114 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3702
Practice Address - Country:US
Practice Address - Phone:574-533-6154
Practice Address - Fax:574-534-3951
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000436A101YA0400X
MI68010910391041C0700X
IN34005513A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)