Provider Demographics
NPI:1588275945
Name:CARLOSH, KRISTEN ANNE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANNE
Last Name:CARLOSH
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 HILLWOOD DR APT G1
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-2658
Mailing Address - Country:US
Mailing Address - Phone:423-915-9532
Mailing Address - Fax:
Practice Address - Street 1:1642 HILLWOOD DR APT G1
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2658
Practice Address - Country:US
Practice Address - Phone:423-915-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000624735101YS0200X
TN4531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty