Provider Demographics
NPI:1962476952
Name:BAXTER, KRIS (MFT)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 MUIR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6626
Mailing Address - Country:US
Mailing Address - Phone:408-772-7110
Mailing Address - Fax:408-296-1639
Practice Address - Street 1:4100 MOORPARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1707
Practice Address - Country:US
Practice Address - Phone:408-772-7110
Practice Address - Fax:408-296-1639
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC24804OtherBBSE LICENSE NUMBER