Provider Demographics
NPI:1336519370
Name:TAYLOR, KRISTINA LOUISE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LOUISE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-493-6000
Mailing Address - Fax:
Practice Address - Street 1:4430 106TH ST SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4711
Practice Address - Country:US
Practice Address - Phone:425-493-6000
Practice Address - Fax:425-493-6015
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60686977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2069370Medicaid