Individual
KRISTI MATHISTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
1115 B STREET, PLUMMER, ID 83851
(208) 686-1931
(208) 686-5813
Mailing address
1115 B STREET, PO BOX 388, PLUMMER, ID 83851
(208) 686-1931
(208) 686-5813
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/19/2011
Last updated
11/19/2011
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