MS. KRISTIN L. RUSSELL MOUTTET (NPI# 1861546368) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861546368 |
| Entity Type | Individual |
| Full Name | MS. KRISTIN L. RUSSELL MOUTTET |
| Credential | M.S. , LMFT |
| Practice Address |
10372 Democracy Ln Fairfax VA 22030-2522 |
| Practice Telephone | 7035912551 |
| Practice Fax Number | 7035912563 |
| Mailing Telephone | 7035912551 |
| Mailing Fax Number | 7035912563 |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | 0717001096 | VA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | ANTHEM - FAIRFAX | 239190 | 01 |
| VA | ANTHEM - STERLING | 239191 | 01 |
| Street Address |
10372 DEMOCRACY LN |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487717914 | James L Alexander | Social Worker | 10372 Democracy Ln, Suite B, Fairfax, VA 22030-2522 | 2006-12-18 |
| 1457733651 | Julie Turner | Counselor | 10372 Democracy Ln, Fairfax, VA 22030-2522 | 2015-06-24 |
| 1740685338 | Steven Fenton Dever | Counselor | 10372 Democracy Ln, Fairfax, VA 22030-2522 | 2014-10-27 |
| 1366867434 | Joy E. Koeppen | Social Worker | 10372 Democracy Ln, B, Fairfax, VA 22030-2522 | 2014-02-26 |
| 1629328083 | Practical Therapeutic Solutions, Pllc | Community/Behavioral Health | 10372 Democracy Ln, Fairfax, VA 22030-2522 | 2012-09-13 |
| 1790051779 | Johnny S Powell | Counselor | 10372 Democracy Ln, Fairfax, VA 22030-2522 | 2012-03-23 |
| 1467729319 | Angela Gilmour | Social Worker | 10372 Democracy Ln, Suite B, Fairfax, VA 22030-2522 | 2011-11-21 |
| 1558552661 | Pamela Jean Masaniello | Counselor | 10372 Democracy Ln, Apt D, Fairfax, VA 22030-2522 | 2007-08-05 |
| 1225158785 | Carla Lynn Messenger | Psychologist | 10372 Democracy Ln, Fairfax, VA 22030-2522 | 2007-03-29 |
| 1275660094 | Beverly Hubble Tauke | Social Worker | 10372 Democracy Ln, Fairfax, VA 22030-2522 | 2007-02-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336755800 | Samantha N Terriss | Marriage & Family Therapist | 80 Dominga Ave, Fairfax, CA 94930-1604 | 2020-09-21 |
| 1417431149 | Jonathan Dixon | Marriage & Family Therapist | 9677 Main St # A-b, Fairfax, VA 22031-3763 | 2018-09-19 |
| 1730579673 | Victoria Alexis Mckenna | Marriage & Family Therapist | 10570 Main St, Apt 511, Fairfax, VA 22030-7113 | 2015-01-30 |
| 1649606187 | Jason Neal Linder | Marriage & Family Therapist | 189 Canyon Road, Fairfax, CA 94930 | 2013-09-16 |
| 1790031854 | Maureen Smith Bethea | Marriage & Family Therapist | 10640 Page Ave Ste 210, Fairfax, VA 22030-4000 | 2012-07-26 |
| 1043549595 | Gail Danchig | Marriage & Family Therapist | 110 Willow Ave, Fairfax, CA 94930-1220 | 2009-12-11 |
| 1407029291 | Amy Ione Holle | Marriage & Family Therapist | 351 Olema Rd, Fairfax, CA 94930-1339 | 2008-04-11 |
| 1295948834 | Alexander Binik | Marriage & Family Therapist | 7 Meadow Way, Fairfax, CA 94930-2151 | 2007-05-08 |
| 1811064090 | Brent L Bowen | Marriage & Family Therapist | 10605 Judicial Dr, Building A-4, Fairfax, VA 22030-5167 | 2006-11-30 |
| 1265031728 | Rachel Cheche Hoover | Marriage & Family Therapist | 10640 Page Ave Ste 210, Fairfax, VA 22030-4000 | 2020-10-25 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.