Provider Demographics
NPI:1548487002
Name:HARRISON, KRISTINE SYLVIA (PSYD,)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:SYLVIA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PSYD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 TROSPER RD SW
Mailing Address - Street 2:108-126
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512
Mailing Address - Country:US
Mailing Address - Phone:360-791-4042
Mailing Address - Fax:
Practice Address - Street 1:203 4TH AVENUE
Practice Address - Street 2:SUITE 320
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-791-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist