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General NPI Number Information
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NPI Number | 1669024238
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Entity Type | Individual
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Provider Name | KRISTIAN HERRON T-CADC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 2410 RING RD STE 500
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7991
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Country | US
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Telephone | 270-982-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 N MILES ST APT G8
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-7950
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Country | US
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Telephone | 270-234-3712
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 255408
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License Number State | KY
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