Provider Demographics
NPI:1336501394
Name:CANDOO, KRISTINE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:
Last Name:CANDOO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:CANDOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 NW GILMAN BOULEVARD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-681-5512
Mailing Address - Fax:
Practice Address - Street 1:1700 NW GILMAN BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2161
Practice Address - Country:US
Practice Address - Phone:425-681-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60624586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health