Provider Demographics
NPI:1659423150
Name:YETSKO, KRISTI (LADC, LCMHC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:YETSKO
Suffix:
Gender:F
Credentials:LADC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 CHILAFOUX RD
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:WEST CHARLESTON
Mailing Address - State:VT
Mailing Address - Zip Code:05872-0099
Mailing Address - Country:US
Mailing Address - Phone:802-754-6516
Mailing Address - Fax:
Practice Address - Street 1:55 SEYMOUR LANE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855
Practice Address - Country:US
Practice Address - Phone:802-334-5246
Practice Address - Fax:802-334-1093
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000271101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor