Provider Demographics
NPI:1982896973
Name:SMITH, KRISTIANN DANIELLE (LFMT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIANN
Middle Name:DANIELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LFMT
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 3641
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98509-3641
Mailing Address - Country:US
Mailing Address - Phone:469-777-8829
Mailing Address - Fax:
Practice Address - Street 1:1145 MOUNTAIN AIRE DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1903
Practice Address - Country:US
Practice Address - Phone:469-777-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40718106H00000X
WALF60742055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist