Provider Demographics
NPI:1447457312
Name:SALAMONE, KRISTINE G (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:G
Last Name:SALAMONE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:SHIELDS
Other - Last Name:GAENZLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-4870
Mailing Address - Fax:682-885-3936
Practice Address - Street 1:1500 COOPER ST FL 4
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2500
Practice Address - Fax:682-885-2510
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist