Provider Demographics
NPI:1578281564
Name:CARBREY, KRISTINA MARIE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:CARBREY
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 1:1301 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1705
Mailing Address - Country:US
Mailing Address - Phone:913-660-3929
Mailing Address - Fax:
Practice Address - Street 1:1301 N 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1705
Practice Address - Country:US
Practice Address - Phone:913-956-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-09-18
Deactivation Date:2023-04-25
Deactivation Code:
Reactivation Date:2023-05-11
Provider Licenses
StateLicense IDTaxonomies
221700000X
KS04676-T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist