Healthcare Provider Details

I. General information

NPI: 1063143766
Provider Name (Legal Business Name): KRISTEN DAHL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 GRANDVIEW DR STE 575
FORT MITCHELL KY
41017-5667
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-6611
  • Fax:
Mailing address:
  • Phone: 888-585-8434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number279002
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: