1669957650 NPI number — KRISTAL LYNN GLAUDE M.A., LMHC

Table of content: KRISTAL LYNN GLAUDE M.A., LMHC (NPI 1669957650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669957650 NPI number — KRISTAL LYNN GLAUDE M.A., LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLAUDE
Provider First Name:
KRISTAL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669957650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 CINDY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02919-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-215-8434
Provider Business Mailing Address Fax Number:
401-921-2436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 CENTERVILLE RD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-4395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-714-7325
Provider Business Practice Location Address Fax Number:
401-921-2436
Provider Enumeration Date:
09/26/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MHC00983 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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