Provider Demographics
NPI:1841369378
Name:CHRISENBERY, KRISTEN CAROLINE (MS)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:CAROLINE
Last Name:CHRISENBERY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:CAROLINE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2101 STONE BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4056
Mailing Address - Country:US
Mailing Address - Phone:503-502-7076
Mailing Address - Fax:
Practice Address - Street 1:2101 STONE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4056
Practice Address - Country:US
Practice Address - Phone:503-502-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008836101YM0800X
ORC1615101YP2500X
CAMFC 46246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional