Provider Demographics
NPI:1447427570
Name:KING-NELSON, KRISTI (CMHC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:KING-NELSON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4441
Mailing Address - Country:US
Mailing Address - Phone:920-437-4024
Mailing Address - Fax:920-437-4343
Practice Address - Street 1:123 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4441
Practice Address - Country:US
Practice Address - Phone:920-437-4024
Practice Address - Fax:920-437-4343
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43592600Medicaid