Provider Demographics
NPI:1508242645
Name:REID, KRISTJANA (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTJANA
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 NE LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97136-9303
Mailing Address - Country:US
Mailing Address - Phone:406-679-2020
Mailing Address - Fax:
Practice Address - Street 1:1402 NE LAKE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:OR
Practice Address - Zip Code:97136-9303
Practice Address - Country:US
Practice Address - Phone:406-679-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8941519-35011041C0700X
UT8941519-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical