Healthcare Provider Details

I. General information

NPI: 1104439934
Provider Name (Legal Business Name): KRISTIN PENN, MA, LMHC (PLLC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S LINCOLN ST STE 150
SPOKANE WA
99201-4443
US

IV. Provider business mailing address

4801 DEER LAKE RD, UNIT 1
CLINTON WA
98236-4005
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-1870
  • Fax:
Mailing address:
  • Phone: 206-324-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTIN PENN
Title or Position: OWNER
Credential: MA, LMHC
Phone: 206-324-1870