Provider Demographics
NPI:1700335635
Name:WHITE, KRISTINA LEE HUBER (LCPC, RPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEE HUBER
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12612 62ND ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066-5111
Mailing Address - Country:US
Mailing Address - Phone:605-359-6235
Mailing Address - Fax:
Practice Address - Street 1:12612 62ND ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066-5111
Practice Address - Country:US
Practice Address - Phone:605-359-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional