Provider Demographics
NPI:1346612660
Name:WEISSENBORN, KRISTEN (LMHCA, ESA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WEISSENBORN
Suffix:
Gender:F
Credentials:LMHCA, ESA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8376 31ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3910
Mailing Address - Country:US
Mailing Address - Phone:425-231-2026
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N STE 407
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8969
Practice Address - Country:US
Practice Address - Phone:425-231-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC-60550453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health