Provider Demographics
NPI:1275157091
Name:MUMAW, KRISTEN JEANETTE (MS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JEANETTE
Last Name:MUMAW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 CHARLES TOWN RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-2669
Mailing Address - Country:US
Mailing Address - Phone:304-901-2070
Mailing Address - Fax:
Practice Address - Street 1:80 WAR MEMORIAL TRL STE B
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-1807
Practice Address - Country:US
Practice Address - Phone:304-258-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV583101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)