Provider Demographics
NPI:1780923946
Name:GALVIN, CHRISTINE KELLER (MA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KELLER
Last Name:GALVIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KELLER
Other - Middle Name:
Other - Last Name:GALVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:2222 STATE AVE NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4764
Mailing Address - Country:US
Mailing Address - Phone:360-480-6586
Mailing Address - Fax:
Practice Address - Street 1:2222 STATE AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4764
Practice Address - Country:US
Practice Address - Phone:360-480-6586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health