Provider Demographics
NPI:1700086766
Name:PICARD, KRISTEN LEE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:PICARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CARNELIAN BAY
Mailing Address - State:CA
Mailing Address - Zip Code:96140-0399
Mailing Address - Country:US
Mailing Address - Phone:530-546-1956
Mailing Address - Fax:534-546-1939
Practice Address - Street 1:5225 NORTH LAKE BLVD
Practice Address - Street 2:
Practice Address - City:CARNELIAN BAY
Practice Address - State:CA
Practice Address - Zip Code:96140-0399
Practice Address - Country:US
Practice Address - Phone:530-546-1956
Practice Address - Fax:534-546-1939
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1648815101YM0800X
CA32303104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health