Provider Demographics
NPI:1912410580
Name:KIMBALL, CRISTEN S (QMHA)
Entity type:Individual
Prefix:
First Name:CRISTEN
Middle Name:S
Last Name:KIMBALL
Suffix:
Gender:
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-0839
Mailing Address - Country:US
Mailing Address - Phone:425-259-3191
Mailing Address - Fax:
Practice Address - Street 1:2802 BROADWAY AVE.
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3642
Practice Address - Country:US
Practice Address - Phone:425-259-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500735658Medicaid