Provider Demographics
NPI:1104439934
Name:KRISTIN PENN, MA, LMHC (PLLC)
Entity type:Organization
Organization Name:KRISTIN PENN, MA, LMHC (PLLC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:206-324-1870
Mailing Address - Street 1:4801 DEER LAKE RD, UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-4005
Mailing Address - Country:US
Mailing Address - Phone:206-324-1870
Mailing Address - Fax:
Practice Address - Street 1:170 S LINCOLN ST STE 150
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4443
Practice Address - Country:US
Practice Address - Phone:206-324-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty