Healthcare Provider Details

I. General information

NPI: 1245362854
Provider Name (Legal Business Name): KATHRYN V WURZBACHER MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13451 SE 36TH ST
BELLEVUE WA
98006-1475
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 425-562-1337
  • Fax: 425-562-1322
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC09786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: