Healthcare Provider Details

I. General information

NPI: 1033464037
Provider Name (Legal Business Name): KRISTINE ALISE KOONTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2054 VISTA PKWY STE 240
WEST PALM BEACH FL
33411-6742
US

IV. Provider business mailing address

2054 VISTA PKWY STE 240
WEST PALM BEACH FL
33411-6742
US

V. Phone/Fax

Practice location:
  • Phone: 407-625-1879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: