Provider Demographics
NPI:1639355977
Name:WARE, KRISTEN GERMAIN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GERMAIN
Last Name:WARE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 W TOURNAMENT DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-8813
Mailing Address - Country:US
Mailing Address - Phone:208-884-1705
Mailing Address - Fax:208-884-5120
Practice Address - Street 1:136 S ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6541
Practice Address - Country:US
Practice Address - Phone:208-884-1705
Practice Address - Fax:208-884-5120
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-4009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional