Provider Demographics
NPI:1780070888
Name:MOORE, KRISTEN (EDD, LMHC)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:EDD, LMHC
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD, LMHC
Mailing Address - Street 1:505 W HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3747
Mailing Address - Country:US
Mailing Address - Phone:360-509-0724
Mailing Address - Fax:360-584-9048
Practice Address - Street 1:719 SLEATER KINNEY RD SE STE 212
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1138
Practice Address - Country:US
Practice Address - Phone:360-509-0724
Practice Address - Fax:360-584-9048
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60522984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health