Provider Demographics
NPI:1801373626
Name:KRENN, CAROLINE MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MARIE
Last Name:KRENN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 TRAIL ST UNIT 206
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1664
Mailing Address - Country:US
Mailing Address - Phone:415-745-5870
Mailing Address - Fax:
Practice Address - Street 1:2825 STOCKYARD RD STE A11
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1544
Practice Address - Country:US
Practice Address - Phone:415-745-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-30836101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health