=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447913348
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN THORSEN M.ED., LMHCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2021
-----------------------------------------------------
Last Update Date | 10/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3035 ISLAND CREST WAY STE 112
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-208-2950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3121 239TH PL SE
-----------------------------------------------------
City | SAMMAMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98075-9415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-208-2950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 61039751
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------