Provider Demographics
NPI:1316364342
Name:PARK, KRISTIN (MSMFT, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MSMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 NORTHWEST BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2676
Mailing Address - Country:US
Mailing Address - Phone:208-219-7043
Mailing Address - Fax:
Practice Address - Street 1:1910 NORTHWEST BLVD STE 206
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2676
Practice Address - Country:US
Practice Address - Phone:208-219-7043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-6819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist