=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346789732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTA MICHELLE MCALLISTER CDP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2017
-----------------------------------------------------
Last Update Date | 02/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9575 ETHAN WADE WAY SE
-----------------------------------------------------
City | SNOQUALMIE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98065-9577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-831-5425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 332 HEALY AVE S APT 5
-----------------------------------------------------
City | NORTH BEND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98045-8953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-891-1519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 60258103
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------