Healthcare Provider Details

I. General information

NPI: 1619150430
Provider Name (Legal Business Name): MS. KRISTEN L. COYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PACIFIC AVE
TACOMA WA
98418-7915
US

IV. Provider business mailing address

3580 PACIFIC AVE
TACOMA WA
98418-7915
US

V. Phone/Fax

Practice location:
  • Phone: 253-798-6130
  • Fax: 253-798-4433
Mailing address:
  • Phone: 253-798-6130
  • Fax: 253-798-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00046859
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: