Healthcare Provider Details

I. General information

NPI: 1649875048
Provider Name (Legal Business Name): GRACE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 7TH AVE STE A
KIRKLAND WA
98033-5779
US

IV. Provider business mailing address

1003 7TH AVE STE A
KIRKLAND WA
98033-5779
US

V. Phone/Fax

Practice location:
  • Phone: 425-658-3016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61593352
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: