Provider Demographics
NPI:1124478334
Name:KRISTIAN KARES KOUNSELING
Entity type:Organization
Organization Name:KRISTIAN KARES KOUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:8
Authorized Official - Middle Name:MONET
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-554-5482
Mailing Address - Street 1:8445 ENGLISH OAK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6988
Mailing Address - Country:US
Mailing Address - Phone:904-554-5482
Mailing Address - Fax:
Practice Address - Street 1:8445 ENGLISH OAK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6988
Practice Address - Country:US
Practice Address - Phone:904-554-5482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11336251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012076600Medicaid