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General NPI Number Information
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NPI Number | 1215126230
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Entity Type | Individual
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Provider Name | KRISTA KELEIGH GLEASON M.A., LAC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 160 ROUTE 9
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City | BAYVILLE
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State | NJ
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Zip | 08721
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Country | US
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Telephone | 732-349-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 309 ROUTE 35 APT. 2H
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City | POINT PLEASANT
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State | NJ
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Zip | 08742
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Country | US
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Telephone | 732-664-3725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 37AC00049200
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License Number State | NJ
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