Healthcare Provider Details

I. General information

NPI: 1679620272
Provider Name (Legal Business Name): BARBARA BLYWISE MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 333RD ST SUITE 129
FEDERAL WAY WA
98003-6309
US

IV. Provider business mailing address

402 S 333RD ST SUITE 129
FEDERAL WAY WA
98003-6309
US

V. Phone/Fax

Practice location:
  • Phone: 253-929-1529
  • Fax: 253-874-4382
Mailing address:
  • Phone: 253-929-1529
  • Fax: 253-874-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00007565
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: