Provider Demographics
NPI:1124332036
Name:DUNCAN, KRISTINE BETH
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:BETH
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:BETH
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 N BISBEE AVE
Mailing Address - Street 2:
Mailing Address - City:WILLCOX
Mailing Address - State:AZ
Mailing Address - Zip Code:85643-1509
Mailing Address - Country:US
Mailing Address - Phone:520-384-8626
Mailing Address - Fax:520-384-4266
Practice Address - Street 1:480 N BISBEE AVE
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1509
Practice Address - Country:US
Practice Address - Phone:520-384-8626
Practice Address - Fax:520-384-4266
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4203650103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool