Provider Demographics
NPI:1982897765
Name:PEDERSON-ARCHULETA, KRISTY L (MS, LMFT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:PEDERSON-ARCHULETA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 POYNTZ AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6760
Mailing Address - Country:US
Mailing Address - Phone:785-539-5455
Mailing Address - Fax:
Practice Address - Street 1:1019 POYNTZ AVE STE C
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6760
Practice Address - Country:US
Practice Address - Phone:785-539-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist