1063989085 NPI number — KRISTEN IHDE, PSYD LLC

Table of content: MR. THOMAS EARL MCKEEHAN JR. BS (NPI 1770881930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063989085 NPI number — KRISTEN IHDE, PSYD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRISTEN IHDE, PSYD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1063989085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 HANCOCK ST STE 120D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02169-4371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 HANCOCK ST STE 120D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
857-241-3711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IHDE
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
857-241-3711

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)