Provider Demographics
NPI:1649643016
Name:WAUGH, KRISTIN MUNCH
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MUNCH
Last Name:WAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:MICHELLE
Other - Last Name:MUNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 RIDGEWAY AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3145
Mailing Address - Country:US
Mailing Address - Phone:757-759-2661
Mailing Address - Fax:
Practice Address - Street 1:1010 RIDGEWAY AVE APT 6
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-3145
Practice Address - Country:US
Practice Address - Phone:757-759-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-07
Last Update Date:2025-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 222Q00000X, 103K00000X
HIRBT-24-353982106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist