Healthcare Provider Details

I. General information

NPI: 1598250672
Provider Name (Legal Business Name): KRISTEN ALLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN MURRAY ED.S, NCSP, LPC

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 E ECHO AVE
WASILLA AK
99654-4436
US

IV. Provider business mailing address

4315 E ECHO AVE
WASILLA AK
99654-4436
US

V. Phone/Fax

Practice location:
  • Phone: 719-684-6310
  • Fax:
Mailing address:
  • Phone: 719-684-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number110769
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: