Basic Information
| Provider Information | |||||||||
| NPI: | 1568701530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RISTER | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW-A, SUDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2429 | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986328486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603539494 | ||||||||
| FaxNumber: | 3603539440 | ||||||||
| Practice Location | |||||||||
| Address1: | 922 FIR ST | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986322525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603539422 | ||||||||
| FaxNumber: | 3603539440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2013 | ||||||||
| LastUpdateDate: | 11/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CO60145336 | WA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | SC61234578 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.