Provider Demographics
NPI:1992176952
Name:WASZTYL, KERISIA (LMFT)
Entity type:Individual
Prefix:
First Name:KERISIA
Middle Name:
Last Name:WASZTYL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 SOUTHLAND TRL
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6061
Mailing Address - Country:US
Mailing Address - Phone:478-321-7733
Mailing Address - Fax:
Practice Address - Street 1:546 SOUTHLAND TRL
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6061
Practice Address - Country:US
Practice Address - Phone:478-321-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist