Individual
AVERY PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHC
Contact information
Practice address
15605 SE 1ST ST, BELLEVUE, WA 98008-4641
(909) 815-4212
Mailing address
7345 164TH AVE NE # 145-239, REDMOND, WA 98052-7846
(909) 815-4212
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC.LH.61116070
WA
Other
Enumeration date
01/08/2018
Last updated
06/19/2021
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