Individual
KELLY KRIETSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2935 SOUTHWEST DR, SEDONA, AZ 86336-3797
(928) 203-4844
(928) 203-4497
Mailing address
1016 W UNIVERSITY AVE, SUITE #202, FLAGSTAFF, AZ 86001-2994
(928) 779-4286
(928) 774-1148
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1554
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12364601
—
AZ
01
—
AZ0614590
BCBS
AZ
Enumeration date
02/22/2007
Last updated
01/21/2009
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