Provider Demographics
NPI:1902214653
Name:KERSTETER MCELROY, KRISTINA (QMHP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:KERSTETER MCELROY
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 SW SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-8997
Mailing Address - Country:US
Mailing Address - Phone:541-475-6575
Mailing Address - Fax:541-504-1195
Practice Address - Street 1:125 SW C ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1458
Practice Address - Country:US
Practice Address - Phone:541-475-6575
Practice Address - Fax:541-504-1195
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool