Healthcare Provider Details

I. General information

NPI: 1962498865
Provider Name (Legal Business Name): KRISTIN R DUENOW LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN R DUENOW-SILLS LMHC

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W BAY DR NW
OLYMPIA WA
98502-4310
US

IV. Provider business mailing address

1670 KENNEDY PL
DUPONT WA
98327-9791
US

V. Phone/Fax

Practice location:
  • Phone: 406-670-2761
  • Fax:
Mailing address:
  • Phone: 406-670-2761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60691611
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61025792
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: