MEDICARE: CHRISTINA KOEPP 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	101Y00000X	Counselor	LH60878120.
2	101Y00000X	Counselor
3	101YM0800X	Mental Health Counselor	MC60419745	WA
4	101YM0800X	Mental Health Counselor	LH60878120	WA

General Provider Information

NPI Number	:	1073949244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA KOEPP LMHC

Provider Business Mailing Address
First Line	:	3403 SW CLOVERDALE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3734
Country	:	US
Telephone Number	:	425-440-1024
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	3403 SW CLOVERDALE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3734
Country	:	US
Telephone Number	:	425-440-1024
Fax Number	:

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

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	04/07/2022

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