Healthcare Provider Details

I. General information

NPI: 1720315005
Provider Name (Legal Business Name): KRISTIEN HOLLINGSWORTH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2009
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 GALISTEO ST
SANTA FE NM
87505-4666
US

IV. Provider business mailing address

1415 GALISTEO ST
SANTA FE NM
87505-4666
US

V. Phone/Fax

Practice location:
  • Phone: 702-325-7689
  • Fax:
Mailing address:
  • Phone: 702-325-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4585
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09368
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17411
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number60084
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC611
License Number StateNV
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6374-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: