Provider Demographics
NPI:1902052442
Name:SPRAGUE, KRISTE BOUVIER (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTE
Middle Name:BOUVIER
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1932
Mailing Address - Country:US
Mailing Address - Phone:207-610-1606
Mailing Address - Fax:
Practice Address - Street 1:5 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1932
Practice Address - Country:US
Practice Address - Phone:207-610-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional