Provider Demographics
NPI:1184901951
Name:KRISTOL HEALING CENTER INC
Entity type:Organization
Organization Name:KRISTOL HEALING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST / V. PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:I
Authorized Official - Last Name:KRISTOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-739-5808
Mailing Address - Street 1:2427 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2001
Mailing Address - Country:US
Mailing Address - Phone:904-739-5808
Mailing Address - Fax:904-739-2528
Practice Address - Street 1:2427 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2001
Practice Address - Country:US
Practice Address - Phone:904-739-5808
Practice Address - Fax:904-739-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75534Medicare UPIN