Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 2016004476 | MO |
Y | 101YP2500X | Professional Counselor | LPC-1897 | WY |
NPI | 1003321332 |
---|---|
Provider Name | Kristina L Bender |
First Address | Jackson, WY 83001-1868 |
Second Address | Jackson, WY 83001-8642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2017 |
Last Update Date | 10/11/2020 |