Healthcare Provider Details

I. General information

NPI: 1073024535
Provider Name (Legal Business Name): DEANNA CHRISTINE DUDLEY-ROSS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEANNA CHRISTINE HOLLOWAY MFTI, LMFT

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 3RD AVE N STE 101
EDMONDS WA
98020-3208
US

IV. Provider business mailing address

131 3RD AVE N STE 101
EDMONDS WA
98020-3208
US

V. Phone/Fax

Practice location:
  • Phone: 949-945-0466
  • Fax:
Mailing address:
  • Phone: 949-945-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61376566
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: