Provider Demographics
NPI:1174874812
Name:KNOWS HIS GUN, KRISTIE L (PSYD)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:KNOWS HIS GUN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E 2ND ST
Mailing Address - Street 2:STE 250
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3076
Mailing Address - Country:US
Mailing Address - Phone:971-832-8550
Mailing Address - Fax:971-832-8551
Practice Address - Street 1:307 E 2ND ST
Practice Address - Street 2:STE 250
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3076
Practice Address - Country:US
Practice Address - Phone:971-832-8550
Practice Address - Fax:971-832-8551
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2677103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical