Healthcare Provider Details

I. General information

NPI: 1457976532
Provider Name (Legal Business Name): CRESAYA EMILIANA KINGSBURY M.A. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRESAYA LYNN LACY M.A. LMHCA

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 ERICKSEN AVENUE NE SUITE 321
BAINBRIDGE ISLAND WA
98110
US

IV. Provider business mailing address

365 ERICKSEN AVENUE NE SUITE 321
BAINBRIDGE ISLAND WA
98110
US

V. Phone/Fax

Practice location:
  • Phone: 206-705-3127
  • Fax:
Mailing address:
  • Phone: 206-705-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LM.70074167
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: