Healthcare Provider Details

I. General information

NPI: 1245585769
Provider Name (Legal Business Name): KRISTEN POPPERT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7791 SW REINDEER AVE
REDMOND OR
97756-8247
US

IV. Provider business mailing address

20429 SE SENDEN LN
BEND OR
97702-3868
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-6855
  • Fax:
Mailing address:
  • Phone: 541-241-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9355862-0610
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: