Individual
KIERSTEN THAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED, LMHC-A
Contact information
Practice address
315 W DODDS ST, BLOOMINGTON, IN 47403-2510
(812) 669-2227
Mailing address
315 W DODDS ST, BLOOMINGTON, IN 47403-2510
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88001380A
IN
Other
Enumeration date
04/05/2022
Last updated
04/05/2022
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