Provider Demographics
NPI:1629299938
Name:ERNEST, KRISTIN ELIZABETH (MED LMFT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:ERNEST
Suffix:
Gender:F
Credentials:MED LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 BROADWAY AVENUE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706
Mailing Address - Country:US
Mailing Address - Phone:208-338-9507
Mailing Address - Fax:208-384-9048
Practice Address - Street 1:1843 BROADWAY AVENUE
Practice Address - Street 2:SUITE 205
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-338-9507
Practice Address - Fax:208-384-9048
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT2769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist