Provider Demographics
NPI:1821350299
Name:MOULTINE, KRISTIN L (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:MOULTINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4614
Mailing Address - Country:US
Mailing Address - Phone:253-534-7000
Mailing Address - Fax:253-534-7099
Practice Address - Street 1:2901 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4614
Practice Address - Country:US
Practice Address - Phone:253-534-7000
Practice Address - Fax:253-534-7099
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600615701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8952612OtherCRIME VICTIMS
WA8952613OtherCRIME VICTIMS
WA8952612OtherCRIME VICTIMS