Provider Demographics
NPI:1942751771
Name:GIBBONS, KRISTA L (MC60701062)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:L
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MC60701062
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW GILMAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5364
Mailing Address - Country:US
Mailing Address - Phone:425-295-7697
Mailing Address - Fax:
Practice Address - Street 1:1700 NW BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-295-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WAMC60701062101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor