Provider Demographics
NPI:1811460736
Name:SQUIRE, KRISTA MARIA (BHS)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIA
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:BHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 SAN JERONIMO DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2870
Mailing Address - Country:US
Mailing Address - Phone:907-793-3600
Mailing Address - Fax:
Practice Address - Street 1:3600 SAN JERONIMO DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2870
Practice Address - Country:US
Practice Address - Phone:907-793-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
AK171M00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator