MEDICARE: KRISTINE A AXE PPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PPC-1505	WY

General Provider Information

NPI Number	:	1477372472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE A AXE PPC

Provider Business Mailing Address
First Line	:	3207 SPARKS RD STE 200
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-6152
Country	:	US
Telephone Number	:	307-369-4710
Fax Number	:	307-222-0279

Provider Business Practice Location Address
First Line	:	3207 SPARKS RD STE 200
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-6152
Country	:	US
Telephone Number	:	307-369-4710
Fax Number	:	307-222-0279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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Directions to “ KRISTINE A AXE PPC” Practice Location

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