Provider Demographics
NPI:1952790370
Name:IZANT, KRISTEN KEEFE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:KEEFE
Last Name:IZANT
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 1:6325 WOODSIDE CT STE 350
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1042
Mailing Address - Country:US
Mailing Address - Phone:410-910-9660
Mailing Address - Fax:
Practice Address - Street 1:6325 WOODSIDE CT STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1042
Practice Address - Country:US
Practice Address - Phone:410-910-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06380103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program