1992112585 NPI number — MISS KRISTINE SHJERVE MA/LPC

Table of content: MISS KRISTINE SHJERVE MA/LPC (NPI 1992112585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992112585 NPI number — MISS KRISTINE SHJERVE MA/LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHJERVE
Provider First Name:
KRISTINE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MA/LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHJERVE
Provider Other First Name:
KRISTI
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA/LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1992112585
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2851 S AVE B
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-376-0026
Provider Business Mailing Address Fax Number:
928-782-2298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2851 S AVE B
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-376-0026
Provider Business Practice Location Address Fax Number:
928-782-2298
Provider Enumeration Date:
07/16/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-13910 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)