Provider Demographics
NPI:1306930367
Name:PRICE, MARYANN KRISTIN (PHD)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:KRISTIN
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:KRISTIN
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:19813 NE 13TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7612
Mailing Address - Country:US
Mailing Address - Phone:360-514-1986
Mailing Address - Fax:
Practice Address - Street 1:19813 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7612
Practice Address - Country:US
Practice Address - Phone:360-514-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001686103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist