Provider Demographics
NPI:1487057964
Name:NICOLE, KIRSTIN ZOE (MACP, MATC, LMHC)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:ZOE
Last Name:NICOLE
Suffix:
Gender:F
Credentials:MACP, MATC, LMHC
Other - Prefix:
Other - First Name:KIRSTIN
Other - Middle Name:NICOLE
Other - Last Name:NAUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACP, MATC
Mailing Address - Street 1:7900 E GREEN LAKE DR N STE 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4818
Mailing Address - Country:US
Mailing Address - Phone:206-569-8425
Mailing Address - Fax:
Practice Address - Street 1:7900 E GREEN LAKE DR N STE 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4818
Practice Address - Country:US
Practice Address - Phone:206-569-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WALH60701110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60701110OtherLICENSED MENTAL HEALTH COUNSELOR