Healthcare Provider Details

I. General information

NPI: 1144313057
Provider Name (Legal Business Name): PEG A FOLEY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26812 118TH AVE E
GRAHAM WA
98338-9220
US

IV. Provider business mailing address

PO BOX 328
LAKEBAY WA
98349-0328
US

V. Phone/Fax

Practice location:
  • Phone: 253-223-4176
  • Fax:
Mailing address:
  • Phone: 253-223-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00000947
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: