Provider Demographics
NPI:1164782785
Name:MACKOELYN, KRISTINA (MS, LMHC, CMIII)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:MACKOELYN
Suffix:
Gender:F
Credentials:MS, LMHC, CMIII
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:MACKOELYN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS (US), LMHC-A, CM
Mailing Address - Street 1:1220 RIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:DARRINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98241
Mailing Address - Country:US
Mailing Address - Phone:513-309-2846
Mailing Address - Fax:
Practice Address - Street 1:1220 RIDDLE ST
Practice Address - Street 2:
Practice Address - City:DARRINGTON
Practice Address - State:WA
Practice Address - Zip Code:98241
Practice Address - Country:US
Practice Address - Phone:513-309-2846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60457973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health