Provider Demographics
NPI:1972988558
Name:PAINTER, KRISTI
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:PAINTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8933 N MISTY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3295 W INA RD
Practice Address - Street 2:150
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2191
Practice Address - Country:US
Practice Address - Phone:520-744-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional