Provider Demographics
NPI:1023262458
Name:MARCHMAN, KRISTA MICHIELS (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MICHIELS
Last Name:MARCHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CELEBRATION BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5159
Mailing Address - Country:US
Mailing Address - Phone:321-559-1222
Mailing Address - Fax:
Practice Address - Street 1:1420 CELEBRATION BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5159
Practice Address - Country:US
Practice Address - Phone:321-559-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS796103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool