Healthcare Provider Details

I. General information

NPI: 1518028901
Provider Name (Legal Business Name): DESTINY ANNE FRAHM L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W MAPLE ST
MCCLEARY WA
98557-9663
US

IV. Provider business mailing address

PO BOX 1075
MCCLEARY WA
98557-1075
US

V. Phone/Fax

Practice location:
  • Phone: 360-495-3031
  • Fax: 360-495-3388
Mailing address:
  • Phone: 360-495-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00010013
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: