Provider Demographics
NPI:1215126230
Name:GLEASON, KRISTA KELEIGH (MA, LAC)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:KELEIGH
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:ELIZABETH
Other - Last Name:KELEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:309 ROUTE 35
Mailing Address - Street 2:APT. 2H
Mailing Address - City:POINT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742
Mailing Address - Country:US
Mailing Address - Phone:732-664-3725
Mailing Address - Fax:
Practice Address - Street 1:160 ROUTE 9
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721
Practice Address - Country:US
Practice Address - Phone:732-349-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00049200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health