Provider Demographics
NPI:1144644709
Name:KREIDER, KRYSTLE KAYLEE (LPCC, LCPC)
Entity type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:KAYLEE
Last Name:KREIDER
Suffix:
Gender:F
Credentials:LPCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 LONE MOOSE CT
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6005
Mailing Address - Country:US
Mailing Address - Phone:505-977-5376
Mailing Address - Fax:
Practice Address - Street 1:2875 TINA AVE STE 106
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1582
Practice Address - Country:US
Practice Address - Phone:406-552-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0181471101YP2500X, 101YP2500X
MTBBH-LCPC-LIC-43090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM6775241Medicaid
MT0687193Medicaid