Provider Demographics
NPI:1053821132
Name:SPURLOCK, KRISTINA MARIE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 MILL CREEK BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1278
Mailing Address - Country:US
Mailing Address - Phone:425-522-2105
Mailing Address - Fax:425-472-1112
Practice Address - Street 1:16300 MILL CREEK BLVD STE 119
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1278
Practice Address - Country:US
Practice Address - Phone:425-522-2105
Practice Address - Fax:425-472-1112
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60797899101YM0800X
WALH60983431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60983431OtherMENTAL HEALTH COUNSELING LICENSE
WAMC60797899OtherLICENSURE