Provider Demographics
NPI:1124388400
Name:WECKESSER, KRISTINA FRANCES (MSC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:FRANCES
Last Name:WECKESSER
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:FRANCES
Other - Last Name:NOWAKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:163 CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-5123
Mailing Address - Country:US
Mailing Address - Phone:702-385-5331
Mailing Address - Fax:
Practice Address - Street 1:4285 N RANCHO DR STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3455
Practice Address - Country:US
Practice Address - Phone:702-385-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool