| Kristie Jo Coppedge, LMHC, LICSW | |
| 20102 Cedar Valley Rd, Suite 104, Lynnwood, WA 98036-6333 | |
| (425) 670-2102 | |
| (425) 670-8081 | 
| Full Name | Kristie Jo Coppedge | 
|---|---|
| Gender | Female | 
| Speciality | Counselor - Mental Health | 
| Location | 20102 Cedar Valley Rd, Lynnwood, Washington | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1093850224 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LH00006307 (Washington) | Primary | 
| 1041C0700X | Social Worker - Clinical | LW00007408 (Washington) | Secondary | 
| Entity Name | Jamestown S'klallam Tribe | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1134181555 PECOS PAC ID: 2365349495 Enrollment ID: O20050507000057 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Kristie Jo Coppedge, LMHC, LICSW 20102 Cedar Valley Rd, Suite 104, Lynnwood, WA 98036-6333 Ph: (425) 670-2102 | Kristie Jo Coppedge, LMHC, LICSW 20102 Cedar Valley Rd, Suite 104, Lynnwood, WA 98036-6333 Ph: (425) 670-2102 | 
| Christine Smith, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 4807 196th St Sw, Suite 220, Lynnwood, WA 98036 Phone: 425-835-5871 Fax: 425-835-5855 | |
| Richard Johnson,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 3810 196th St Sw Ste 11, Lynnwood, WA 98036 Phone: 425-288-4900 Fax: 425-248-4703 | |
| Yohan Chung,  Counselor Medicare: Not Enrolled in Medicare Practice Location: 4629 168th St Sw Ste E, Lynnwood, WA 98037 Phone: 425-776-1290 Fax: 425-776-1298 | |
| Mrs. Kirstie Lynn Davis,  Counselor Medicare: Medicare Enrolled Practice Location: 4807 196th St Sw, Lynnwood, WA 98036 Phone: 425-835-5850 | |
| Leslie Catherine Olivia Bourgoin, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 4807 196th St Sw Ste 220, Lynnwood, WA 98036 Phone: 425-835-5850 Fax: 425-835-5855 | |
| Miss Danielle Florence Honanie, CO60690975 Counselor Medicare: Not Enrolled in Medicare Practice Location: 3910 188th St Sw, Lynnwood, WA 98037 Phone: 425-329-9484 | |
| Elise Pate, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 19321 44th Ave W, Lynnwood, WA 98036 Phone: 000-000-0000 Fax: 000-000-0000 |