Provider Demographics
NPI:1720720485
Name:LIND, KRYSTLE (MS)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:LIND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 N BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1203
Mailing Address - Country:US
Mailing Address - Phone:866-485-0905
Mailing Address - Fax:
Practice Address - Street 1:1225 N BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-1203
Practice Address - Country:US
Practice Address - Phone:866-485-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00501100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health