Provider Demographics
NPI:1427865922
Name:MCCORMACK, KRISTEN FRANCINE (MA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:FRANCINE
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 S MILL POINT LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-8511
Mailing Address - Country:US
Mailing Address - Phone:775-420-0566
Mailing Address - Fax:
Practice Address - Street 1:2530 S MILL POINT LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-8511
Practice Address - Country:US
Practice Address - Phone:775-420-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4761177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health