Provider Demographics
NPI:1396918728
Name:ZEIDNER, KRISTINA (LMFT, LSAC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:ZEIDNER
Suffix:
Gender:F
Credentials:LMFT, LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1350
Mailing Address - Country:US
Mailing Address - Phone:801-787-6562
Mailing Address - Fax:
Practice Address - Street 1:14 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1350
Practice Address - Country:US
Practice Address - Phone:801-787-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5072211-3902101YA0400X
UT507221-6006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)