Provider Demographics
NPI:1538473004
Name:MINER, KRISTINA MARIE (LCSW, LAC, MSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:MINER
Suffix:
Gender:F
Credentials:LCSW, LAC, MSW
Other - Prefix:MRS
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 NORTH AVE W STE 106
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5500
Mailing Address - Country:US
Mailing Address - Phone:406-544-7678
Mailing Address - Fax:406-926-3117
Practice Address - Street 1:1600 NORTH AVE W STE 106
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5500
Practice Address - Country:US
Practice Address - Phone:406-544-7678
Practice Address - Fax:406-926-3117
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1354101YA0400X
MT9991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)