Provider Demographics
NPI:1316558927
Name:FURY, KRISTINA SYLLA
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SYLLA
Last Name:FURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NE 195TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-1460
Mailing Address - Country:US
Mailing Address - Phone:925-478-1258
Mailing Address - Fax:
Practice Address - Street 1:2525 NE 195TH ST APT 101
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-1460
Practice Address - Country:US
Practice Address - Phone:925-478-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MG61042067101Y00000X
WAMG61042067101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor