Provider Demographics
NPI:1588400642
Name:KRISTINE TERRY PHD PLLC
Entity type:Organization
Organization Name:KRISTINE TERRY PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-287-1301
Mailing Address - Street 1:13750 W COLONIAL DR STE 350
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6148
Mailing Address - Country:US
Mailing Address - Phone:570-287-1301
Mailing Address - Fax:
Practice Address - Street 1:566 W BAY ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2631
Practice Address - Country:US
Practice Address - Phone:570-287-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty