Provider Demographics
NPI:1609321603
Name:DURENE, KRISTINA NICOLE
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:NICOLE
Last Name:DURENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 S MERIDIAN STE C348
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3603
Mailing Address - Country:US
Mailing Address - Phone:253-527-7783
Mailing Address - Fax:
Practice Address - Street 1:1420 S MERIDIAN STE C
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-6914
Practice Address - Country:US
Practice Address - Phone:253-527-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60922020101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health