Provider Demographics
NPI:1699213678
Name:RIPLEY, KYRA (AA, CDP)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:AA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13821 BEVERLY PARK RD
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087
Mailing Address - Country:US
Mailing Address - Phone:425-329-9611
Mailing Address - Fax:
Practice Address - Street 1:13821 BEVERLY PARK RD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087
Practice Address - Country:US
Practice Address - Phone:425-329-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60488627101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)