Provider Demographics
NPI:1003638784
Name:CORY, KRISTA NICOLE
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:NICOLE
Last Name:CORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:NICOLE
Other - Last Name:BARGAMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12021 100TH AVE NE APT 3C
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3810
Mailing Address - Country:US
Mailing Address - Phone:425-324-0188
Mailing Address - Fax:
Practice Address - Street 1:12021 100TH AVE NE APT 3C
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3810
Practice Address - Country:US
Practice Address - Phone:425-324-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61478995106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist