Provider Demographics
NPI:1801085980
Name:JAMES, KRISTAL
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:JAMES
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 1:1876 W 150 N
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8070
Mailing Address - Country:US
Mailing Address - Phone:801-695-1316
Mailing Address - Fax:801-649-0964
Practice Address - Street 1:749 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2228
Practice Address - Country:US
Practice Address - Phone:801-695-1316
Practice Address - Fax:801-649-0964
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50908206004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional