Provider Demographics
NPI:1992038921
Name:YEOUZE, KRISTINA A (MA, PMFT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:A
Last Name:YEOUZE
Suffix:
Gender:F
Credentials:MA, PMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:ST. JOSEPH'S CHILDREN'S HOME
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240
Mailing Address - Country:US
Mailing Address - Phone:307-532-4197
Mailing Address - Fax:
Practice Address - Street 1:1419 MAIN ST
Practice Address - Street 2:ST. JOSEPH'S CHILDREN'S HOME
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3340
Practice Address - Country:US
Practice Address - Phone:307-532-4197
Practice Address - Fax:307-532-8405
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY#PMFT-236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist