MEDICARE: KRISTIN R DUENOW LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP60691611	MT
2	171M00000X	Case Manager/Care Coordinator
3	101YM0800X	Mental Health Counselor	LH61025792	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	760820	OTHER	MT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1962498865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN R DUENOW LMHC

Provider Business Mailing Address
First Line	:	1670 KENNEDY PL
Second Line	:
City	:	DUPONT
State	:	WA
Zip	:	98327-9791
Country	:	US
Telephone Number	:	406-670-2761
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 W BAY DR NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4310
Country	:	US
Telephone Number	:	406-670-2761
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	08/12/2024

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