Provider Demographics
NPI:1215821723
Name:LEBARON, KRISTA
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:LEBARON
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 1:15641 S WINGED TRACE CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2515
Mailing Address - Country:US
Mailing Address - Phone:801-598-2171
Mailing Address - Fax:
Practice Address - Street 1:165 W CANYON CREST RD STE 140
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1995
Practice Address - Country:US
Practice Address - Phone:801-893-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142262823502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker