Provider Demographics
NPI:1205966652
Name:KAISER, CHRISTINE JUNE (LADAC, LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JUNE
Last Name:KAISER
Suffix:
Gender:F
Credentials:LADAC, LMHC
Other - Prefix:
Other - First Name:TRINA
Other - Middle Name:JUNE
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:425 E SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-3437
Mailing Address - Country:US
Mailing Address - Phone:575-313-5278
Mailing Address - Fax:866-536-4769
Practice Address - Street 1:118 W 13TH ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5139
Practice Address - Country:US
Practice Address - Phone:575-388-1447
Practice Address - Fax:575-388-1447
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0128881101YA0400X
NM0152391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid