| 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: Accepting Medicare Assignments 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 |