Healthcare Provider Details

I. General information

NPI: 1720720485
Provider Name (Legal Business Name): KRYSTLE LIND MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 01/12/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S BROADWAY # 7
PITMAN NJ
08071-2235
US

IV. Provider business mailing address

140 S BROADWAY # 7
PITMAN NJ
08071-2235
US

V. Phone/Fax

Practice location:
  • Phone: 856-426-6263
  • Fax:
Mailing address:
  • Phone: 844-365-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00501100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00859000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: