Basic Information
| Provider Information | |||||||||
| NPI: | 1073171286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRENCH | ||||||||
| FirstName: | KRISTAN | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3883 N 3570 E | ||||||||
| Address2: | |||||||||
| City: | KIMBERLY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833415407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9409234796 | ||||||||
| FaxNumber: | 2087367089 | ||||||||
| Practice Location | |||||||||
| Address1: | 1363 FILLMORE ST | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087367090 | ||||||||
| FaxNumber: | 2087367089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2019 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LMSWI-38697 | ID | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW-42196 | ID | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.