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General NPI Number Information
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NPI Number | 1023762176
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Entity Type | Organization
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Legal Business Name | JEAN L KRISTELLER PH D
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Dates
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Enumeration Date | 02/08/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | THE MAPLE CENTER ATTN: JEAN KRISTELLER 1801 N 6TH ST STE 600
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City | TERRE HAUTE
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State | IN
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Zip | 47804-4047
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Country | US
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Telephone | 812-240-5790
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Fax |
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Provider Business Mailing Address
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Address Line | 4435 LANCASHIRE CT
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City | TERRE HAUTE
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State | IN
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Zip | 47803-2092
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Country | US
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Telephone | 812-877-3760
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEAN LORRAINE KRISTELLER
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Credential | PH D, LCP
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Telephone | 812-877-3760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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