Healthcare Provider Details

I. General information

NPI: 1154231322
Provider Name (Legal Business Name): KRISTEN SUE DOUBLE MA, LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OAK AVE
KITTANNING PA
16201-2708
US

IV. Provider business mailing address

200 OAK AVE
KITTANNING PA
16201-2708
US

V. Phone/Fax

Practice location:
  • Phone: 724-548-7607
  • Fax: 724-545-9997
Mailing address:
  • Phone: 724-548-7607
  • Fax: 724-545-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002828
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: