Provider Demographics
NPI:1023247384
Name:BOSWOOD, KRISTINA GUTGESELL (MED, LPC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:GUTGESELL
Last Name:BOSWOOD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:KRISTEL
Other - Middle Name:GUTGESELL
Other - Last Name:BOSWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:122 1ST AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4803
Mailing Address - Country:US
Mailing Address - Phone:907-452-8251
Mailing Address - Fax:907-459-3810
Practice Address - Street 1:122 1ST AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4803
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3810
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCO P 735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional