Provider Demographics
NPI:1679812648
Name:STANTON, KRISTAL M (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:M
Last Name:STANTON
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 1:1608 W 80TH DR
Mailing Address - Street 2:
Mailing Address - City:OSBORNE
Mailing Address - State:KS
Mailing Address - Zip Code:67473-8812
Mailing Address - Country:US
Mailing Address - Phone:785-346-6015
Mailing Address - Fax:
Practice Address - Street 1:1205 18TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2704
Practice Address - Country:US
Practice Address - Phone:785-346-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional