| Doctor Name: | MRS. KRISTINA MARIE PUGH |
| NPI Number: | 1003842741 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW |
| License Number: | X-07258 |
| Business Practice Address: | 13802 Quintessa St Caldwell, ID - 836075153 |
| Business Phone Number: | 8015997123 |
| Business Fax Number: | |
| Mailing Address: | 13802 Quintessa St, CALDWELL |
| State: | ID |
| Postal Code: | 836075153 |
| Phone Number: | 8015997123 |
| Fax Number: | |
| NPI Enumeration Date: | 06/24/2006 |
| NPI Last Update Date: | 03/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | X-07258 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |