Provider Demographics
NPI:1497580781
Name:GOULETTE, KRISTEN
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GOULETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 OLD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FERRISBURGH
Mailing Address - State:VT
Mailing Address - Zip Code:05473-6003
Mailing Address - Country:US
Mailing Address - Phone:802-777-6482
Mailing Address - Fax:
Practice Address - Street 1:432 OLD HOLLOW RD
Practice Address - Street 2:
Practice Address - City:NORTH FERRISBURGH
Practice Address - State:VT
Practice Address - Zip Code:05473-6003
Practice Address - Country:US
Practice Address - Phone:802-777-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135773101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health