Provider Demographics
NPI:1578872701
Name:ERSKINE, KRISTIN (LPC NCC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ERSKINE
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-3654
Mailing Address - Country:US
Mailing Address - Phone:801-949-2219
Mailing Address - Fax:
Practice Address - Street 1:70 N MAIN ST STE 130
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6101
Practice Address - Country:US
Practice Address - Phone:801-298-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56620626004171M00000X
NC227861171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator