Provider Demographics
NPI:1902073190
Name:WALLIN, KRISTIN HUGHES (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:HUGHES
Last Name:WALLIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21847
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-1847
Mailing Address - Country:US
Mailing Address - Phone:505-821-5894
Mailing Address - Fax:505-404-6452
Practice Address - Street 1:9412 INDIAN SCHOOL RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2878
Practice Address - Country:US
Practice Address - Phone:505-821-5894
Practice Address - Fax:505-404-6452
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005817106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist