Provider Demographics
NPI:1497588685
Name:MERTZ, KRISTINA GRACE (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:GRACE
Last Name:MERTZ
Suffix:
Gender:F
Credentials:LICSW
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 421
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-3993
Mailing Address - Fax:509-474-6960
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:ST 660E
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-474-3993
Practice Address - Fax:509-474-6960
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA615609041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical