Provider Demographics
NPI:1508068990
Name:WYLDE, CHRISTINE RENEE (MA LMHC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:RENEE
Last Name:WYLDE
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:PO BOX 4794
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2269
Mailing Address - Country:US
Mailing Address - Phone:206-321-2887
Mailing Address - Fax:
Practice Address - Street 1:600 FIRST AVE
Practice Address - Street 2:SUITE 430-A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2269
Practice Address - Country:US
Practice Address - Phone:206-321-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH0005647101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health