Provider Demographics
NPI:1619344744
Name:KRISSY PERRY INC
Entity Type:Organization
Organization Name:KRISSY PERRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LMHC, RPT
Authorized Official - Phone:405-919-5089
Mailing Address - Street 1:16020 SE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-4907
Mailing Address - Country:US
Mailing Address - Phone:405-919-5089
Mailing Address - Fax:
Practice Address - Street 1:4205 148TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-7114
Practice Address - Country:US
Practice Address - Phone:425-968-5948
Practice Address - Fax:425-658-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60579749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty