Provider Demographics
NPI:1386760452
Name:SOUZA, KRISTINE SUSAN (LMFT)
Entity type:Individual
Prefix:MISS
First Name:KRISTINE
Middle Name:SUSAN
Last Name:SOUZA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 CORRALES RD STE 205
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9348
Mailing Address - Country:US
Mailing Address - Phone:505-385-0439
Mailing Address - Fax:
Practice Address - Street 1:3949 CORRALES RD STE 205
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9348
Practice Address - Country:US
Practice Address - Phone:505-385-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NM0114541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist