Provider Demographics
NPI:1962741629
Name:CHAMPIGNON, KRISTY ELWOOD (LMHC, LPC, PMH-C)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:ELWOOD
Last Name:CHAMPIGNON
Suffix:
Gender:F
Credentials:LMHC, LPC, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 WHITE HORSE AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-2624
Mailing Address - Country:US
Mailing Address - Phone:609-269-4732
Mailing Address - Fax:
Practice Address - Street 1:168 WHITE HORSE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-2624
Practice Address - Country:US
Practice Address - Phone:609-269-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005410101YM0800X
NJ37PC00559900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health