Provider Demographics
NPI:1518516566
Name:VASOSAUST, KRISTEN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:VASOSAUST
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10234 WITHERS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6834
Mailing Address - Country:US
Mailing Address - Phone:980-401-2790
Mailing Address - Fax:
Practice Address - Street 1:1922 E SECRETARIAT DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1752
Practice Address - Country:US
Practice Address - Phone:980-401-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional