Healthcare Provider Details

I. General information

NPI: 1427160027
Provider Name (Legal Business Name): MICHELE MARIE CRIST PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE MARIE HENRY PH.D.

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 FAR HILLS AVE
KETTERING OH
45429-2386
US

IV. Provider business mailing address

5450 FAR HILLS AVE
KETTERING OH
45429-2386
US

V. Phone/Fax

Practice location:
  • Phone: 937-554-7156
  • Fax:
Mailing address:
  • Phone: 937-554-7156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2583
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: