Provider Demographics
NPI:1780048652
Name:KRISTEN L SCHMIDT PHD
Entity type:Organization
Organization Name:KRISTEN L SCHMIDT PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-264-2485
Mailing Address - Street 1:1801 N MERIDIAN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5257
Mailing Address - Country:US
Mailing Address - Phone:850-264-2485
Mailing Address - Fax:850-523-0864
Practice Address - Street 1:1801 N MERIDIAN RD
Practice Address - Street 2:SUITE C
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5257
Practice Address - Country:US
Practice Address - Phone:850-264-2485
Practice Address - Fax:850-523-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3LW0DOtherBCBSFL
FLPY6955OtherPSYCHOLOGY LICENSE