Provider Demographics
NPI:1386414852
Name:THARP, KRISTINE JEAN (TCADC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:JEAN
Last Name:THARP
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W BROADWAY STE 29
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9030
Mailing Address - Country:US
Mailing Address - Phone:712-328-3700
Mailing Address - Fax:
Practice Address - Street 1:300 W BROADWAY STE 29
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9030
Practice Address - Country:US
Practice Address - Phone:712-328-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT23122101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)