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General NPI Number Information
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NPI Number | 1629143284
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Entity Type | Individual
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Provider Name | JEAN L. KRISTELLER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 02/07/2022
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Provider Practice Location 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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Provider Business Mailing Address
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Address Line | PSYCHOLOGY DEPARTMENT INDIANA STATE UNIVERSITY
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City | TERRE HAUTE
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State | IN
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Zip | 47809-0001
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Country | US
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Telephone | 812-237-2467
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Fax | 812-237-4378
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20040676A
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License Number State | IN
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