Provider Demographics
NPI:1518375963
Name:KRISTINE M PING, ACSW, LCSW PC
Entity Type:Organization
Organization Name:KRISTINE M PING, ACSW, LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PING
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW, PC
Authorized Official - Phone:765-404-6411
Mailing Address - Street 1:865 RENAISSANCE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-1223
Mailing Address - Country:US
Mailing Address - Phone:765-404-6411
Mailing Address - Fax:765-449-1758
Practice Address - Street 1:865 RENAISSANCE ST
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1223
Practice Address - Country:US
Practice Address - Phone:765-404-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)