Provider Demographics
NPI:1598821951
Name:PLUMMER, KRISTINE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:M
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 S 800 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3827
Mailing Address - Country:US
Mailing Address - Phone:801-295-5566
Mailing Address - Fax:
Practice Address - Street 1:1466 N HIGHWAY 89 STE 220
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2738
Practice Address - Country:US
Practice Address - Phone:801-336-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT345512-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health