Provider Demographics
NPI:1316317803
Name:HOLUM, KRISTI (LPC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:HOLUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BROWN DUCK DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6602
Mailing Address - Country:US
Mailing Address - Phone:307-290-2192
Mailing Address - Fax:
Practice Address - Street 1:201 W LAKEWAY RD STE 311
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6306
Practice Address - Country:US
Practice Address - Phone:307-363-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-921101YM0800X
WY2032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health