| Doctor Name: | JORDANNA LAVINA BURKETT CRIST |
| NPI Number: | 1659679686 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | LCPC 2226 |
| Business Practice Address: | 210 W 4th St Scott City, KS - 678711168 |
| Business Phone Number: | 6208725338 |
| Business Fax Number: | 6208722879 |
| Mailing Address: | 210 W 4th St, SCOTT CITY |
| State: | KS |
| Postal Code: | 678711168 |
| Phone Number: | 6208725338 |
| Fax Number: | 6208722879 |
| NPI Enumeration Date: | 02/28/2011 |
| NPI Last Update Date: | 02/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LCPC 2226 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |