Provider Demographics
NPI:1912073917
Name:SCHMIDT, KRISTEN LEIGH (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEIGH
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6955103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74439OtherBCBS OF FL PROVIDER ID
FL3LW0DOtherBCBSFL