Krista Lyn Dettle

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

37AC00059600 Issued in NJ

Practice address

38 Glenwood Ave
Lake Hiawatha, NJ 07034-1013

Phone

(201) 787-6939

NPI assigned

Mar 18, 2010

Last updated

Mar 18, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268870400000",
    "number": "1699099689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 GLENWOOD AVE",
            "city": "LAKE HIAWATHA",
            "state": "NJ",
            "postal_code": "070341013",
            "telephone_number": "201-787-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 GLENWOOD AVE",
            "city": "LAKE HIAWATHA",
            "state": "NJ",
            "postal_code": "070341013",
            "telephone_number": "201-787-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTLE",
        "first_name": "KRISTA",
        "middle_name": "LYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37AC00059600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Lake Hiawatha, NJ
• Providers in Lake Hiawatha, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.