Provider Demographics
NPI:1619693041
Name:PESCATORE, KRISTINA (LPCA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:PESCATORE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 NE SHADOW BROOK PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6494
Mailing Address - Country:US
Mailing Address - Phone:512-887-0202
Mailing Address - Fax:
Practice Address - Street 1:754 NW BROADWAY ST STE 100&207
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2776
Practice Address - Country:US
Practice Address - Phone:541-668-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health