Provider Demographics
NPI:1215635552
Name:PRICE, KRISTINE RENEE (LCPC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:RENEE
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 E MAIN ST STE 9
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4739
Mailing Address - Country:US
Mailing Address - Phone:406-589-6095
Mailing Address - Fax:
Practice Address - Street 1:37 E MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4739
Practice Address - Country:US
Practice Address - Phone:406-589-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT62410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health