Provider Demographics
NPI:1215763420
Name:THRONEBERRY, KIRSTEN PAIGE (LMHCA)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:PAIGE
Last Name:THRONEBERRY
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5618
Mailing Address - Country:US
Mailing Address - Phone:206-939-0441
Mailing Address - Fax:
Practice Address - Street 1:3724 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5618
Practice Address - Country:US
Practice Address - Phone:206-939-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61434389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health