Provider Demographics
NPI:1912461187
Name:GARNER, KRISTINE (MAS-MFT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:MAS-MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 E MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2224
Mailing Address - Country:US
Mailing Address - Phone:480-215-3493
Mailing Address - Fax:
Practice Address - Street 1:2500 S POWER RD STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6688
Practice Address - Country:US
Practice Address - Phone:480-382-1257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-6067T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist