Provider Demographics
NPI:1144041450
Name:PACE, CRISTINA ELIZABETH (LIMHP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELIZABETH
Last Name:PACE
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N BROADWELL AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2153
Mailing Address - Country:US
Mailing Address - Phone:308-395-3247
Mailing Address - Fax:
Practice Address - Street 1:3111 COLLEGE ST APT 131
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1736
Practice Address - Country:US
Practice Address - Phone:760-401-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health