Provider Demographics
NPI:1346484185
Name:PRICE, CRISTINE (LPC, LSAC, NCSP)
Entity Type:Individual
Prefix:
First Name:CRISTINE
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:LPC, LSAC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84339-9508
Mailing Address - Country:US
Mailing Address - Phone:435-245-6967
Mailing Address - Fax:435-755-6707
Practice Address - Street 1:965 S 100 W STE 203
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6071
Practice Address - Country:US
Practice Address - Phone:435-752-1976
Practice Address - Fax:435-755-6707
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT270389-6006101YA0400X
UT270389-6004101YP2500X
UT35585103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool