Provider Demographics
NPI:1235837691
Name:ANDERSEN, KRISTINE (LMSW, PSY-DC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:LMSW, PSY-DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 E GRAY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3408
Mailing Address - Country:US
Mailing Address - Phone:480-674-7404
Mailing Address - Fax:
Practice Address - Street 1:7580 E GRAY RD STE 201
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3408
Practice Address - Country:US
Practice Address - Phone:480-674-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-20723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health