Provider Demographics
NPI:1174831721
Name:SKOOG, KRISTINA LYNN (MS, LPC-S, CCTP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:LYNN
Last Name:SKOOG
Suffix:
Gender:F
Credentials:MS, LPC-S, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 873814
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-3814
Mailing Address - Country:US
Mailing Address - Phone:907-947-6863
Mailing Address - Fax:
Practice Address - Street 1:11350 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7425
Practice Address - Country:US
Practice Address - Phone:907-802-6595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCOP915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional