Provider Demographics
NPI:1346641636
Name:LIKIARDOPOULOS, CRISTINETTE (T-LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINETTE
Middle Name:
Last Name:LIKIARDOPOULOS
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1711
Mailing Address - Country:US
Mailing Address - Phone:316-530-2963
Mailing Address - Fax:
Practice Address - Street 1:215 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1711
Practice Address - Country:US
Practice Address - Phone:316-530-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist