Provider Demographics
NPI:1457129280
Name:MOYER, KRISTEN E (MS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:MOYER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:E
Other - Last Name:MEDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13955 WAKEFIELD PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4516
Mailing Address - Country:US
Mailing Address - Phone:317-863-9002
Mailing Address - Fax:
Practice Address - Street 1:9961 CROSSPOINT BLVD # 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3391
Practice Address - Country:US
Practice Address - Phone:317-585-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN12889245101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health