Provider Demographics
NPI:1720278229
Name:KITTILSTAD, KRISTI MARIE (PLPC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MARIE
Last Name:KITTILSTAD
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:MARIE
Other - Last Name:QUICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:305 W WALL ST STE A
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2477
Mailing Address - Country:US
Mailing Address - Phone:816-380-5896
Mailing Address - Fax:
Practice Address - Street 1:305 W WALL ST STE A
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2477
Practice Address - Country:US
Practice Address - Phone:816-380-5896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional