Provider Demographics
NPI:1992112585
Name:SHJERVE, KRISTINE (MA/LPC)
Entity type:Individual
Prefix:MISS
First Name:KRISTINE
Middle Name:
Last Name:SHJERVE
Suffix:
Gender:F
Credentials:MA/LPC
Other - Prefix:MISS
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:SHJERVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA/LPC
Mailing Address - Street 1:2851 S AVE B
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-376-0026
Mailing Address - Fax:928-782-2298
Practice Address - Street 1:2851 S AVE B
Practice Address - Street 2:SUITE 4
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-376-0026
Practice Address - Fax:928-782-2298
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional