| Doctor Name: | MRS. KRISTI PACK |
| NPI Number: | 1144626458 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPA |
| License Number: | |
| Business Practice Address: | 921 S Lake Dr Prestonsburg, KY - 416531343 |
| Business Phone Number: | 6062634714 |
| Business Fax Number: | 6062634712 |
| Mailing Address: | 921 S Lake Dr, PRESTONSBURG |
| State: | KY |
| Postal Code: | 416531343 |
| Phone Number: | 6062634714 |
| Fax Number: | 6062634712 |
| NPI Enumeration Date: | 11/13/2014 |
| NPI Last Update Date: | 11/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |