Provider Demographics
NPI:1831540095
Name:KRISTEN GENZANO THERAPY LLC
Entity type:Organization
Organization Name:KRISTEN GENZANO THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GENZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-250-5932
Mailing Address - Street 1:8885 SW CANYON RD STE 215
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3429
Mailing Address - Country:US
Mailing Address - Phone:971-712-6260
Mailing Address - Fax:
Practice Address - Street 1:8885 SW CANYON RD STE 215
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-3429
Practice Address - Country:US
Practice Address - Phone:971-712-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty