Provider Demographics
NPI:1558411413
Name:DEROCHE, KRISTA LYNN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:DEROCHE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:LYNN
Other - Last Name:FEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:2110 IRON ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4123
Mailing Address - Country:US
Mailing Address - Phone:360-734-2664
Mailing Address - Fax:360-671-8006
Practice Address - Street 1:2110 IRON ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4123
Practice Address - Country:US
Practice Address - Phone:360-734-2664
Practice Address - Fax:360-671-8006
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health