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General NPI Number Information
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NPI Number | 1205299161
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Entity Type | Organization
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Legal Business Name | KRIS FITZGERALD, LMHC, PLLC
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 116 BROOKSHIRE DR
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City | LAKE WALES
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State | FL
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Zip | 33898-7601
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Country | US
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Telephone | 863-241-2785
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3657
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City | LAKE WALES
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State | FL
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Zip | 33859-3657
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Country | US
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Telephone | 863-241-2785
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | KRISTEN T FITZGERALD
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Credential | LMHC
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Telephone | 863-241-2785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 13651
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License Number State | FL
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