Healthcare Provider Details

I. General information

NPI: 1669392742
Provider Name (Legal Business Name): KRISLYN MOORE LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 BRIDGEPORT WAY W # E2
UNIVERSITY PLACE WA
98466-4328
US

IV. Provider business mailing address

1204 98TH STREET CT E
TACOMA WA
98445-4073
US

V. Phone/Fax

Practice location:
  • Phone: 360-464-7935
  • Fax:
Mailing address:
  • Phone: 253-678-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70135644
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: