MEDICARE: KRISTIN LEE LITTLE LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	00010215	WA

General Provider Information

NPI Number	:	1073755633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN LEE LITTLE LMHC

Provider Business Mailing Address
First Line	:	3617 31ST AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-1710
Country	:	US
Telephone Number	:	206-295-8673
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N 36TH ST
Second Line	:	#327
City	:	SEATTLE
State	:	WA
Zip	:	98103-8697
Country	:	US
Telephone Number	:	206-295-8673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2009
Last Update Date	:	08/26/2009

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