Provider Demographics
NPI:1427484013
Name:FERNALD, KRISTIN (KRISTIN FERNALD LMHC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:FERNALD
Suffix:
Gender:F
Credentials:KRISTIN FERNALD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SALMON BERRY LN
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-8526
Mailing Address - Country:US
Mailing Address - Phone:360-468-3785
Mailing Address - Fax:
Practice Address - Street 1:98 SALMON BERRY LN
Practice Address - Street 2:
Practice Address - City:LOPEZ ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98261-8526
Practice Address - Country:US
Practice Address - Phone:360-468-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60160850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health