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General NPI Number Information
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NPI Number | 1427877208
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Entity Type | Organization
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Legal Business Name | CRISTINAS CLOSET
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2363 S KENNEDY LN # 3
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City | YUMA
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State | AZ
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Zip | 85365-2416
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Country | US
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Telephone | 928-390-0613
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Fax |
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Provider Business Mailing Address
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Address Line | 4407 S AGAVE AVE
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City | YUMA
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State | AZ
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Zip | 85365-6395
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Country | US
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Telephone | 928-390-0613
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | CRISTINA MARIE MCINNES
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Credential |
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Telephone | 928-390-0613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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