Provider Demographics
NPI:1457538845
Name:DISNEY, KRYSTLE LAYNE
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:LAYNE
Last Name:DISNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:LAYNE
Other - Last Name:DISNEY-BINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 S HOWARD ST STE 321
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3816
Mailing Address - Country:US
Mailing Address - Phone:509-838-4128
Mailing Address - Fax:509-838-4816
Practice Address - Street 1:7 S HOWARD ST STE 321
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3816
Practice Address - Country:US
Practice Address - Phone:509-838-4128
Practice Address - Fax:509-838-4816
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00059657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health