Provider Demographics
NPI:1760035018
Name:DUNLAP, KRISTINE L (MS, LAC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:L
Other - Last Name:KILGORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2940 E RIVIERA PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 W CHANDLER BLVD STE 220
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6162
Practice Address - Country:US
Practice Address - Phone:480-250-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17975101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor