Provider Demographics
NPI:1891238556
Name:PARK, CHRISTINE (LMFT, ATR)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 SE 46TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-3221
Mailing Address - Country:US
Mailing Address - Phone:425-891-9525
Mailing Address - Fax:
Practice Address - Street 1:15001 SE 46TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-3221
Practice Address - Country:US
Practice Address - Phone:206-395-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60630037106H00000X
221700000X
WALF60985203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist