Provider Demographics
NPI:1639553845
Name:ARENZ, KRISTIN (RADTI)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ARENZ
Suffix:
Gender:F
Credentials:RADTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 SERVICE CT APT B
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9279
Mailing Address - Country:US
Mailing Address - Phone:530-957-7796
Mailing Address - Fax:
Practice Address - Street 1:7020 SERVICE CT APT B
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9279
Practice Address - Country:US
Practice Address - Phone:530-957-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)