Provider Demographics
NPI:1386105013
Name:PULIDO, CRYSTAL (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:PULIDO
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 NE 140TH ST APT 401
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3565
Mailing Address - Country:US
Mailing Address - Phone:206-794-9939
Mailing Address - Fax:
Practice Address - Street 1:619 N 35TH ST STE 310
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8641
Practice Address - Country:US
Practice Address - Phone:206-459-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60710179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health