Basic Information
| Provider Information | |||||||||
| NPI: | 1225271919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOBERING | ||||||||
| FirstName: | KRISTINE | ||||||||
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| Credential: | LSCSW, LCAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 HUNTER AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665038008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397208 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 HUEBNER RD | ||||||||
| Address2: | |||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397208 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2009 | ||||||||
| LastUpdateDate: | 12/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 971 | NE | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | NE | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 0904007059 | VA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 3746 | NE | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 1374 | NE | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 4476 | KS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.