Provider Demographics
NPI:1053861419
Name:BUDA, KRISTA
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:BUDA
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 1:748 S 825 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4390
Mailing Address - Country:US
Mailing Address - Phone:352-256-2560
Mailing Address - Fax:
Practice Address - Street 1:748 S 825 E
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4390
Practice Address - Country:US
Practice Address - Phone:352-256-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12344815-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042611055OtherTAX ID
MA99618201OtherNETWORK HEALTH
MA1004745OtherFALLON
MA1004745OtherNHP
MA0000023532OtherBMC
MAM18633OtherBCBS
MA1303287OtherMBHP