Healthcare Provider Details

I. General information

NPI: 1952014029
Provider Name (Legal Business Name): KRISTA ZODY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 5TH AVE
FAIRBANKS AK
99701-5025
US

IV. Provider business mailing address

PO BOX 83605
FAIRBANKS AK
99708-3605
US

V. Phone/Fax

Practice location:
  • Phone: 907-374-7776
  • Fax:
Mailing address:
  • Phone: 907-347-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number202004
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: