Provider Demographics
NPI:1992888176
Name:STUART, KRISTOPHER D (LMFT)
Entity type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:D
Last Name:STUART
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 SE ASHLEY PL
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3238
Mailing Address - Country:US
Mailing Address - Phone:541-471-2991
Mailing Address - Fax:
Practice Address - Street 1:1205 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1423
Practice Address - Country:US
Practice Address - Phone:541-441-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0493106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist