Healthcare Provider Details

I. General information

NPI: 1124403449
Provider Name (Legal Business Name): KRISTEN HUBER, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 LACEY RD STE 7
FORKED RIVER NJ
08731-1051
US

IV. Provider business mailing address

1044 LACEY RD STE 7
FORKED RIVER NJ
08731-1051
US

V. Phone/Fax

Practice location:
  • Phone: 609-276-0608
  • Fax:
Mailing address:
  • Phone: 609-276-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37PC00480200
License Number StateNJ

VIII. Authorized Official

Name: MRS. KRISTEN LAUREN THOMPSON-HUBER
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LPC
Phone: 609-276-0608