Basic Information
Provider Information
NPI: 1003002015
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OHLENFORST
FirstName: KRISTEN
MiddleName: M.
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12820 HILLCREST RD # C119
Address2:  
City: DALLAS
State: TX
PostalCode: 752301526
CountryCode: US
TelephoneNumber: 2147556119
FaxNumber:  
Practice Location
Address1: 12820 HILLCREST RD # C119
Address2:  
City: DALLAS
State: TX
PostalCode: 752301526
CountryCode: US
TelephoneNumber: 2147556119
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2007
LastUpdateDate: 01/03/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X21664CAN Behavioral Health & Social Service ProvidersPsychologistClinical
103TC0700X34408TXY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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