Provider Demographics
NPI:1992552129
Name:FLIS, KRISTEN ELIZABETH (EDS,LPES, NCSP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:FLIS
Suffix:
Gender:F
Credentials:EDS,LPES, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 TRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6469
Mailing Address - Country:US
Mailing Address - Phone:407-754-4921
Mailing Address - Fax:
Practice Address - Street 1:110 CLEBOURNE ST UNIT 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-1743
Practice Address - Country:US
Practice Address - Phone:803-310-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4747103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool