Provider Demographics
NPI:1164134672
Name:DOHSE, KRISTOPHER (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:
Last Name:DOHSE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 N HUMPHREYS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3070
Mailing Address - Country:US
Mailing Address - Phone:602-892-4726
Mailing Address - Fax:
Practice Address - Street 1:624 N HUMPHREYS ST STE 2
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3070
Practice Address - Country:US
Practice Address - Phone:602-892-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional