Provider Demographics
NPI:1902303324
Name:WASHBURN, KRISTEN PERRY (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:PERRY
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:PHYLLIS
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 NOAHS LANE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-704-4977
Mailing Address - Fax:
Practice Address - Street 1:101 NOAHS LANE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130
Practice Address - Country:US
Practice Address - Phone:812-704-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000285A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist