Provider Demographics
NPI:1134613334
Name:KRISTEN DAVIS-JOHN, LLC
Entity type:Organization
Organization Name:KRISTEN DAVIS-JOHN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS-JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-892-4082
Mailing Address - Street 1:6714 JOSIE DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-2502
Mailing Address - Country:US
Mailing Address - Phone:813-892-4082
Mailing Address - Fax:813-907-9494
Practice Address - Street 1:2100 ASHLEY OAKS CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6416
Practice Address - Country:US
Practice Address - Phone:813-892-4082
Practice Address - Fax:813-907-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5228103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty