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NPI Code Detail

MEDICARE: MRS. KRISTEN LEONARD FLY MFT

MEDICARE: MRS. KRISTEN LEONARD FLY MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFTINTERN, IMF 49868CA
2106H00000XMarriage & Family Therapist0717001230VA

General Provider Information

NPI Number : 1548395478
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTEN LEONARD FLY MFT
Provider Business Mailing Address
First Line : 718 J CLYDE MORRIS BLVD
Second Line : SUITE D
City : NEWPORT NEWS
State : VA
Zip : 23601-1540
Country : US
Telephone Number : 757-912-5359
Fax Number : 757-595-1885
Provider Business Practice Location Address
First Line : 718 J CLYDE MORRIS BLVD
Second Line : SUITE D
City : NEWPORT NEWS
State : VA
Zip : 23601-1540
Country : US
Telephone Number : 757-912-5359
Fax Number : 757-595-1885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 12/08/2011

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