Provider Demographics
NPI:1023659364
Name:EGELSTON, KRIS (QMHA, CADC 1-R, CRM)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:EGELSTON
Suffix:
Gender:F
Credentials:QMHA, CADC 1-R, CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 26TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-1350
Mailing Address - Country:US
Mailing Address - Phone:541-944-0262
Mailing Address - Fax:
Practice Address - Street 1:8111 26TH ST
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-1350
Practice Address - Country:US
Practice Address - Phone:541-944-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-24-4066101YA0400X
OR106S00000X
OR22-QMHA-R-2828101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician