Healthcare Provider Details

I. General information

NPI: 1457807331
Provider Name (Legal Business Name): GINGER MICHEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/09/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19125 NORTH CREEK PARKWAY 123B
BOTHELL WA
98011
US

IV. Provider business mailing address

130 2ND AVE N UNIT 1712
EDMONDS WA
98020-2121
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-7264
  • Fax: 206-565-0269
Mailing address:
  • Phone: 425-954-7264
  • Fax: 206-565-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60896220
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1255092920
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerTYPE 2 NPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: