Provider Demographics
NPI:1356897334
Name:DAVIS-JOHN, KRISTEN (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:DAVIS-JOHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ASHLEY OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6416
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
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5228103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling