Provider Demographics
NPI:1720076136
Name:KNOLL, KRISTIN (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KNOLL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 DON PASQUAL RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8493
Mailing Address - Country:US
Mailing Address - Phone:505-865-3350
Mailing Address - Fax:505-865-4739
Practice Address - Street 1:735 DON PASQUAL RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8493
Practice Address - Country:US
Practice Address - Phone:505-865-3350
Practice Address - Fax:505-865-4739
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM80441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health