Provider Demographics
NPI:1770113987
Name:COUNTZLER, CHRISTIAN (PSS)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:COUNTZLER
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 MAXWELTON CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-4012
Mailing Address - Country:US
Mailing Address - Phone:859-551-7322
Mailing Address - Fax:
Practice Address - Street 1:635 MAXWELTON CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-4012
Practice Address - Country:US
Practice Address - Phone:859-551-7322
Practice Address - Fax:859-252-1935
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1181158175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist