Provider Demographics
NPI:1669504239
Name:CABE, KRISTINA RUTH
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:RUTH
Last Name:CABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 E VILLA RITA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9534
Mailing Address - Country:US
Mailing Address - Phone:206-779-5925
Mailing Address - Fax:623-435-6328
Practice Address - Street 1:8045 N 47TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-6402
Practice Address - Country:US
Practice Address - Phone:623-435-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3689393103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool