Provider Demographics
NPI:1457643165
Name:EARSOM, KRISTIE DAWN (PLMHP NCC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:DAWN
Last Name:EARSOM
Suffix:
Gender:F
Credentials:PLMHP NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BURLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2177
Mailing Address - Country:US
Mailing Address - Phone:308-995-6691
Mailing Address - Fax:308-995-6830
Practice Address - Street 1:10730 737 RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:NE
Practice Address - Zip Code:68958-5806
Practice Address - Country:US
Practice Address - Phone:308-876-2327
Practice Address - Fax:308-876-2130
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9323101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health