Provider Demographics
NPI:1972074888
Name:STRATFORD, KRISTIN KIMBERLY (LCPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KIMBERLY
Last Name:STRATFORD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W KENT AVE # 2741
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-9998
Mailing Address - Country:US
Mailing Address - Phone:406-544-2833
Mailing Address - Fax:
Practice Address - Street 1:1100 W KENT AVE # 2741
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-9998
Practice Address - Country:US
Practice Address - Phone:406-544-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-36862101YP2500X
MTBBH-PCLC-LIC-29945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-PCLC-LIC-29945OtherNEW STATE LICENSE