Provider Demographics
NPI:1780391896
Name:BATISTA, KRYSTAL (R-DMT, RI-LMHC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:BATISTA
Suffix:
Gender:F
Credentials:R-DMT, RI-LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10124 COLT LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9011
Mailing Address - Country:US
Mailing Address - Phone:321-246-5332
Mailing Address - Fax:
Practice Address - Street 1:10124 COLT LN
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9011
Practice Address - Country:US
Practice Address - Phone:321-246-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty