Provider Demographics
NPI:1326320904
Name:ENBLOM, KRISTEN (LPCC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ENBLOM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4949
Mailing Address - Country:US
Mailing Address - Phone:406-442-1914
Mailing Address - Fax:
Practice Address - Street 1:45 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4949
Practice Address - Country:US
Practice Address - Phone:406-442-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND726-8-15-12-214101YP2500X
MT32809101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1477745370Medicaid