Provider Demographics
NPI:1174816680
Name:KIRSCH, KRISTINE ANN (MCOUN, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ANN
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MCOUN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S CANVASBACK WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3715
Mailing Address - Country:US
Mailing Address - Phone:208-830-8658
Mailing Address - Fax:208-342-7030
Practice Address - Street 1:3350 W AMERICANA TER
Practice Address - Street 2:SUITE #215
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2521
Practice Address - Country:US
Practice Address - Phone:208-830-8658
Practice Address - Fax:208-342-0667
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health