Individual
KRIS EGELSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA, CADC 1-R, CRM
Contact information
Practice address
8111 26TH ST, WHITE CITY, OR 97503-1350
(541) 944-0262
Mailing address
8111 26TH ST, WHITE CITY, OR 97503-1350
(541) 944-0262
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
22-QMHA-R-2828
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-24-4066
OR
106S00000X
Behavior Technician
—
OR
Other
Enumeration date
10/07/2019
Last updated
06/30/2024
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