Provider Demographics
NPI:1033250956
Name:CROTTY, KRISTA MONTANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MONTANA
Last Name:CROTTY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:MONTANA
Other - Last Name:KUBIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 W MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0112
Mailing Address - Country:US
Mailing Address - Phone:509-904-6404
Mailing Address - Fax:
Practice Address - Street 1:220 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0112
Practice Address - Country:US
Practice Address - Phone:509-904-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WALF60066896106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1033250956Medicaid