Provider Demographics
NPI:1669348496
Name:MAHAFFEY, KRISTIN ADRIANNE (MFT-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ADRIANNE
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:MFT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 N WORLD CUP WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7328
Mailing Address - Country:US
Mailing Address - Phone:208-908-6568
Mailing Address - Fax:
Practice Address - Street 1:1953 N WORLD CUP WAY
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7328
Practice Address - Country:US
Practice Address - Phone:208-908-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014896106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist