Healthcare Provider Details

I. General information

NPI: 1306292792
Provider Name (Legal Business Name): EMILY PERNA MMT, LMHC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7522 221ST PL SW
EDMONDS WA
98026-8029
US

IV. Provider business mailing address

23133 80TH PL W
EDMONDS WA
98026-8715
US

V. Phone/Fax

Practice location:
  • Phone: 425-521-6533
  • Fax: 425-775-7210
Mailing address:
  • Phone: 267-320-0706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61473896
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: