Provider Demographics
NPI:1467969303
Name:PETERSON, CHRISTA ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:ELIZABETH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20113 NE 122ND PL
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-5646
Mailing Address - Country:US
Mailing Address - Phone:206-940-4744
Mailing Address - Fax:
Practice Address - Street 1:18500 156TH AVE NE STE 202
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4459
Practice Address - Country:US
Practice Address - Phone:206-946-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60581327103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist