Individual
KRISTINE WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1236 PARIS PIKE, GEORGETOWN, KY 40324-9701
(502) 320-7175
Mailing address
1733 JOSEPHINE RD, STAMPING GROUND, KY 40379-9687
(502) 320-7175
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0779
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
09/13/2012
Last updated
01/27/2014
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