1447664180 NPI number — KRIS ELDRIDGE, LPC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447664180 NPI number — KRIS ELDRIDGE, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRIS ELDRIDGE, LPC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447664180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2045 S VINEYARD
Provider Second Line Business Mailing Address:
SUITE 139
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85210-6889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-499-3542
Provider Business Mailing Address Fax Number:
480-718-8762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2045 S VINEYARD
Provider Second Line Business Practice Location Address:
SUITE 139
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85210-6889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-499-3542
Provider Business Practice Location Address Fax Number:
480-718-8762
Provider Enumeration Date:
06/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ELDRIDGE
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
602-499-3542

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LPC-15142 , 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)





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