Provider Demographics
NPI:1124628797
Name:MARCERON, KRISTA P (MAC, LMHC)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:P
Last Name:MARCERON
Suffix:
Gender:F
Credentials:MAC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-7111
Mailing Address - Country:US
Mailing Address - Phone:206-398-9107
Mailing Address - Fax:
Practice Address - Street 1:1421 34TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3634
Practice Address - Country:US
Practice Address - Phone:206-398-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00009911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health