Provider Demographics
NPI:1407515794
Name:KRISTIN ELIZABETH COUNSELING AND MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:KRISTIN ELIZABETH COUNSELING AND MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GUMZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-817-1310
Mailing Address - Street 1:120 N 50TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-2800
Mailing Address - Country:US
Mailing Address - Phone:206-817-1310
Mailing Address - Fax:
Practice Address - Street 1:120 N 50TH AVE STE A
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-2800
Practice Address - Country:US
Practice Address - Phone:206-817-1310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty