Provider Demographics
NPI:1841811296
Name:MATH, KRISTEN X (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:MATH
Suffix:X
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4538
Mailing Address - Country:US
Mailing Address - Phone:320-492-4582
Mailing Address - Fax:
Practice Address - Street 1:1603 PEBBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4538
Practice Address - Country:US
Practice Address - Phone:320-492-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02229103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty