Provider Demographics
NPI:1992096812
Name:WAGNER, KRISTIN ST LAURENT (LCPC)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ST LAURENT
Last Name:WAGNER
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 1:225 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2223
Mailing Address - Country:US
Mailing Address - Phone:406-252-1177
Mailing Address - Fax:
Practice Address - Street 1:225 N 23RD ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2223
Practice Address - Country:US
Practice Address - Phone:406-252-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional