Provider Demographics
NPI:1376045666
Name:PONTE, KRISTEN LINNAE (MFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LINNAE
Last Name:PONTE
Suffix:
Gender:F
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14672 PEACEFUL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-6505
Mailing Address - Country:US
Mailing Address - Phone:831-332-7291
Mailing Address - Fax:
Practice Address - Street 1:333 SUNRISE AVE STE 701
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3483
Practice Address - Country:US
Practice Address - Phone:916-783-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist