Provider Demographics
NPI:1598076689
Name:HOUSE, KYRA EDEN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KYRA
Middle Name:EDEN
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 BRAWNE AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4806
Mailing Address - Country:US
Mailing Address - Phone:360-250-5831
Mailing Address - Fax:
Practice Address - Street 1:120 STATE AVE NE STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1131
Practice Address - Country:US
Practice Address - Phone:360-250-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60160833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health