Provider Demographics
NPI:1316952161
Name:KRISTI KETZ, PH.D., P.S.
Entity type:Organization
Organization Name:KRISTI KETZ, PH.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:K
Authorized Official - Last Name:KETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-747-1440
Mailing Address - Street 1:421 W RIVERSIDE AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2458
Mailing Address - Country:US
Mailing Address - Phone:509-747-1440
Mailing Address - Fax:509-747-4420
Practice Address - Street 1:421 W RIVERSIDE AVE STE 310
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2458
Practice Address - Country:US
Practice Address - Phone:509-747-1440
Practice Address - Fax:509-747-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 2852103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122336Medicaid