Provider Demographics
NPI:1669814927
Name:LAIRD, CRISTIN PAIGE (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:PAIGE
Last Name:LAIRD
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 S GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3805
Mailing Address - Country:US
Mailing Address - Phone:901-753-4300
Mailing Address - Fax:901-751-8105
Practice Address - Street 1:2262 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3805
Practice Address - Country:US
Practice Address - Phone:901-753-4300
Practice Address - Fax:901-751-8105
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170GMedicaid