MEDICARE: KRISTINA MARIE RUNDELL 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP60893510	WA
2	101YM0800X	Mental Health Counselor	LH60921213	WA

General Provider Information

NPI Number	:	1861921587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MARIE RUNDELL LMHC

Provider Business Mailing Address
First Line	:	950 BROADWAY STE 402
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98402-4454
Country	:	US
Telephone Number	:	253-365-7738
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 BROADWAY STE 402
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98402-4454
Country	:	US
Telephone Number	:	253-365-7738
Fax Number	:

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

Provider Enumeration Date	:	06/06/2017
Last Update Date	:	03/05/2026

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