Provider Demographics
NPI:1639173479
Name:KISHEL, CHRISTEN A (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:A
Last Name:KISHEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 S SOUTHEAST BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-7419
Mailing Address - Country:US
Mailing Address - Phone:509-993-8301
Mailing Address - Fax:509-474-0927
Practice Address - Street 1:400 S JEFFERSON ST STE 318
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3143
Practice Address - Country:US
Practice Address - Phone:509-993-8301
Practice Address - Fax:509-474-0927
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2917103TC0700X
WAPY00002917103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8402877Medicaid
WA8402877Medicaid
WA8807667Medicare ID - Type Unspecified