Provider Demographics
NPI:1083474787
Name:WISE-AVRETT, KRISTIE RENEE (LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:RENEE
Last Name:WISE-AVRETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-1403
Mailing Address - Country:US
Mailing Address - Phone:229-232-1260
Mailing Address - Fax:
Practice Address - Street 1:255 BUTLER AVE STE 300
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6308
Practice Address - Country:US
Practice Address - Phone:717-875-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001601106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist