Healthcare Provider Details

I. General information

NPI: 1336409580
Provider Name (Legal Business Name): SALLY KAY RYE-GOMES MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SALLY KAY RYE LMHC

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16727 59TH PL W
LYNNWOOD WA
98037-8309
US

IV. Provider business mailing address

16727 59TH PL W
LYNNWOOD WA
98037-8309
US

V. Phone/Fax

Practice location:
  • Phone: 206-854-9517
  • Fax:
Mailing address:
  • Phone: 206-854-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00006318
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-17273
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: