Provider Demographics
NPI:1861921587
Name:RUNDELL, KRISTINA MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:RUNDELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 BROADWAY STE 402
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4454
Mailing Address - Country:US
Mailing Address - Phone:253-365-7738
Mailing Address - Fax:
Practice Address - Street 1:950 BROADWAY STE 402
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4454
Practice Address - Country:US
Practice Address - Phone:253-365-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60921213101YM0800X
WA60646439106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health