Provider Demographics
NPI:1003321332
Name:BENDER, KRISTINA L (MS LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:BENDER
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 1868
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1868
Mailing Address - Country:US
Mailing Address - Phone:307-733-2046
Mailing Address - Fax:307-733-6289
Practice Address - Street 1:35 SNOW FOREST DR # 7348
Practice Address - Street 2:
Practice Address - City:STAR VALLEY RANCH
Practice Address - State:WY
Practice Address - Zip Code:83127-5130
Practice Address - Country:US
Practice Address - Phone:573-330-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016004476101YP2500X
WYLPC-1897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional