Provider Demographics
NPI:1912415175
Name:GUEVARA, KRISTINE NICOLE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:NICOLE
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:NICOLE
Other - Last Name:MANIULIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 2083
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-2083
Mailing Address - Country:US
Mailing Address - Phone:253-330-7179
Mailing Address - Fax:
Practice Address - Street 1:5102 26TH ST E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2104
Practice Address - Country:US
Practice Address - Phone:253-330-7179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60923877101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator