Provider Demographics
NPI:1639595259
Name:KREIDLER, MICHAEL (MFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KREIDLER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR NOTCH
Mailing Address - State:PA
Mailing Address - Zip Code:18706-2019
Mailing Address - Country:US
Mailing Address - Phone:570-589-0140
Mailing Address - Fax:
Practice Address - Street 1:189 MARKET ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5400
Practice Address - Country:US
Practice Address - Phone:570-961-3361
Practice Address - Fax:570-961-3364
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist