Healthcare Provider Details

I. General information

NPI: 1700772787
Provider Name (Legal Business Name): KRISTINE AUGELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE LUNDGREN

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 COURT ST STE 210
JACKSON CA
95642-2163
US

IV. Provider business mailing address

601 COURT ST STE 210
JACKSON CA
95642-2163
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-1980
  • Fax: 209-257-1989
Mailing address:
  • Phone: 209-257-1980
  • Fax: 209-257-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: