Healthcare Provider Details

I. General information

NPI: 1235660671
Provider Name (Legal Business Name): AMELIA MCCORMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33455 6TH AVE S
FEDERAL WAY WA
98003-6074
US

IV. Provider business mailing address

33455 6TH AVE S
FEDERAL WAY WA
98003-6074
US

V. Phone/Fax

Practice location:
  • Phone: 253-210-4230
  • Fax: 253-308-2109
Mailing address:
  • Phone: 253-210-4230
  • Fax: 253-308-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: