Provider Demographics
NPI:1538676895
Name:MCVEY, KRISTINE MARIE
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:MCVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KRISTINE MCVEY 8712 N MAGNOLIA AVE
Mailing Address - Street 2:#292
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4451
Mailing Address - Country:US
Mailing Address - Phone:928-581-4559
Mailing Address - Fax:
Practice Address - Street 1:KRISTINE MCVEY 8712 N MAGNOLIA AVE
Practice Address - Street 2:#292
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4451
Practice Address - Country:US
Practice Address - Phone:928-581-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15-02722106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15-02722Medicaid