Healthcare Provider Details

I. General information

NPI: 1992038921
Provider Name (Legal Business Name): KRISTINA A YEOUZE M.A., PMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 MAIN ST ST. JOSEPH'S CHILDREN'S HOME
TORRINGTON WY
82240-3340
US

IV. Provider business mailing address

PO BOX 1117 ST. JOSEPH'S CHILDREN'S HOME
TORRINGTON WY
82240
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-4197
  • Fax: 307-532-8405
Mailing address:
  • Phone: 307-532-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number#PMFT-236
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: