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NPI Code Detail

MEDICARE: KRISTA MICHELLE BARRON BIVENS

MEDICARE: KRISTA MICHELLE BARRON BIVENS
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
1101YM0800XMental Health CounselorIL

General Provider Information

NPI Number : 1770415630
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTA MICHELLE BARRON BIVENS
Provider Business Mailing Address
First Line : 2200 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-3454
Country : US
Telephone Number : 217-698-7150
Fax Number : 217-698-7085
Provider Business Practice Location Address
First Line : 2200 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-3454
Country : US
Telephone Number : 217-698-7150
Fax Number : 217-698-7085
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ KRISTA MICHELLE BARRON BIVENS ” Practice Location

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