Provider Demographics
NPI:1154913663
Name:MECHOSO, KRISTIE (LPC-MHSP, LADAC II)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:MECHOSO
Suffix:
Gender:F
Credentials:LPC-MHSP, LADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 SAINFOIN WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3074
Mailing Address - Country:US
Mailing Address - Phone:305-490-0457
Mailing Address - Fax:
Practice Address - Street 1:2030 SAINFOIN WAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-3074
Practice Address - Country:US
Practice Address - Phone:305-490-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5316101Y00000X
TN1379101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)