# CHILD & ADOLESCENT TREATMENT CENTER

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Krissa E Kirby
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306039243
- **Authorized official:** MR. ROBERT C COOLIDGE (AGENT/REPRESENTATIVE)
- **Authorized official phone:** (386) 774-5211

## Contact information

- **Practice address:** 1950 LEE RD, SUITE 202, WINTER PARK, FL 32789-1859
- **Practice address phone:** (407) 739-5874
- **Practice address fax:** (407) 644-1292
- **Mailing address:** PO BOX 741240, ORANGE CITY, FL 32774-1240
- **Mailing address phone:** (386) 774-5211
- **Mailing address fax:** (386) 774-5251

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | PY6399 | FL | Yes |

## Other

- **Enumeration date:** 08/23/2007
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 54725 | FL BLUE SHIELD | FL |