Healthcare Provider Details

I. General information

NPI: 1710095617
Provider Name (Legal Business Name): MARY S NASH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 BAKER RD. SUITE 8
EASTSOUND WA
98245-8057
US

IV. Provider business mailing address

PO BOX 454
OLGA WA
98279-0454
US

V. Phone/Fax

Practice location:
  • Phone: 360-317-6166
  • Fax: 360-376-6182
Mailing address:
  • Phone: 360-317-6166
  • Fax: 360-376-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00001425
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: