Provider Demographics
NPI:1780097709
Name:WESTOVER, KRISTLE J (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:MRS
First Name:KRISTLE
Middle Name:J
Last Name:WESTOVER
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:389 ADAMS STREET
Mailing Address - Street 2:BOX 376
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0376
Mailing Address - Country:US
Mailing Address - Phone:307-885-9883
Mailing Address - Fax:307-885-5206
Practice Address - Street 1:389 ADAMS STREET
Practice Address - Street 2:BOX 376
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0376
Practice Address - Country:US
Practice Address - Phone:307-885-9883
Practice Address - Fax:307-885-5206
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WYPCSW582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional