Provider Demographics
NPI:1033624556
Name:KRISTIN ROESSLER, LLC
Entity Type:Organization
Organization Name:KRISTIN ROESSLER, LLC
Other - Org Name:DISCOVER HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:425-870-0895
Mailing Address - Street 1:512 91ST AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2566
Mailing Address - Country:US
Mailing Address - Phone:425-870-0895
Mailing Address - Fax:425-377-1764
Practice Address - Street 1:512 91ST AVE NE STE C
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2566
Practice Address - Country:US
Practice Address - Phone:425-870-0895
Practice Address - Fax:425-377-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60591592261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649365149Medicaid