Provider Demographics
NPI:1497891899
Name:DUDLEY, KRISTA J (MA LMHC)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:J
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 N 26TH
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407
Mailing Address - Country:US
Mailing Address - Phone:253-691-0250
Mailing Address - Fax:253-752-6202
Practice Address - Street 1:4409 N 26TH
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407
Practice Address - Country:US
Practice Address - Phone:253-691-0250
Practice Address - Fax:253-752-6202
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004172103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60240483OtherUBI