Provider Demographics
NPI:1427623594
Name:MALOTT, KRISTINA SUZZANNE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SUZZANNE
Last Name:MALOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-8402
Mailing Address - Country:US
Mailing Address - Phone:513-753-9964
Mailing Address - Fax:
Practice Address - Street 1:25 WHITNEY DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8402
Practice Address - Country:US
Practice Address - Phone:513-753-9964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional