Provider Demographics
NPI:1235488248
Name:COSTON, KRISTEN (LMHC, CMHS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:COSTON
Suffix:
Gender:F
Credentials:LMHC, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 R AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2276
Mailing Address - Country:US
Mailing Address - Phone:360-299-4017
Mailing Address - Fax:
Practice Address - Street 1:1601 R AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2276
Practice Address - Country:US
Practice Address - Phone:360-299-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health