Healthcare Provider Details

I. General information

NPI: 1194642595
Provider Name (Legal Business Name): DAVID KRISTOFZSKI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3815 RIVER CROSSING PKWY STE 100
INDIANAPOLIS IN
46240-7766
US

IV. Provider business mailing address

PO BOX 414
HEBRON IN
46341-0414
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 574-220-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34012904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: