Healthcare Provider Details

I. General information

NPI: 1215285085
Provider Name (Legal Business Name): KRYSTAL ASHLEY DAVIS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAL ASHLEY MILLET LMFT

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

IV. Provider business mailing address

16710 NE 79TH ST STE 103
REDMOND WA
98052-4466
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6673
  • Fax:
Mailing address:
  • Phone: 425-298-3844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60165473
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60312435
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: