Provider Demographics
NPI:1871003020
Name:LINDSTROM, KATELYN LANAE OLDEN (LMFTA, SUDP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:LANAE OLDEN
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:LMFTA, SUDP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:LANAE
Other - Last Name:OLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9117 238TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8903
Mailing Address - Country:US
Mailing Address - Phone:425-563-8729
Mailing Address - Fax:
Practice Address - Street 1:9117 238TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8903
Practice Address - Country:US
Practice Address - Phone:425-563-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60903443106H00000X
WACP60347230101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)