Healthcare Provider Details

I. General information

NPI: 1114750775
Provider Name (Legal Business Name): MARY KATE PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8284 28TH CT NE STE A
LACEY WA
98516-7161
US

IV. Provider business mailing address

8284 28TH CT NE STE A
LACEY WA
98516-7161
US

V. Phone/Fax

Practice location:
  • Phone: 360-915-3221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC70079197
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: