Basic Information
| Provider Information | |||||||||
| NPI: | 1871241562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBER | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | LMHC, ATR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31913 3RD PL SW APT D | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980234692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089109973 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9600 VETERANS DR SW | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984930003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003298387 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2022 | ||||||||
| LastUpdateDate: | 07/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 12883 | MA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 221700000X | 21-405 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist |
No ID Information.