Provider Demographics
NPI:1508878315
Name:KIETZMAN, KAREN JOHNSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JOHNSON
Last Name:KIETZMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 VILLAGE LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2497
Mailing Address - Country:US
Mailing Address - Phone:406-248-4153
Mailing Address - Fax:
Practice Address - Street 1:2475 VILLAGE LN
Practice Address - Street 2:SUITE 104
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2497
Practice Address - Country:US
Practice Address - Phone:406-248-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0493337Medicaid
MT50931OtherBLUE CROSS BLUE SHEILD
MT141721OtherVALUEOPTIONS
MT104140OtherNEW WEST HEALTH SERVICES