=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588704100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTINE ANN TRAUCHT L.M.B.T., N.C.M.M.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 WESTERN BLVD STE B
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28546-6822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-381-2262
-----------------------------------------------------
Fax | 910-346-0988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 WESTERN BLVD STE B
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28546-6822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-381-2262
-----------------------------------------------------
Fax | 910-346-0988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 5806
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------