MEDICARE: ALLIYAH DAVAULT MA, LMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHCA.MC.70129444	WA

General Provider Information

NPI Number	:	1366372922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLIYAH DAVAULT MA, LMHCA

Provider Business Mailing Address
First Line	:	PO BOX 1062
Second Line	:
City	:	SNOHOMISH
State	:	WA
Zip	:	98291-1062
Country	:	US
Telephone Number	:	425-327-2859
Fax Number	:

Provider Business Practice Location Address
First Line	:	9623-32ND STREET SE
Second Line	:	BUILDING A-UNIT 111
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258
Country	:	US
Telephone Number	:	425-327-2859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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