Healthcare Provider Details

I. General information

NPI: 1851218580
Provider Name (Legal Business Name): MACY M MULLEN-RACCA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 MYRTLE ST
MOUNT VERNON WA
98273-3849
US

IV. Provider business mailing address

403 MYRTLE ST
MOUNT VERNON WA
98273-3849
US

V. Phone/Fax

Practice location:
  • Phone: 425-474-0909
  • Fax:
Mailing address:
  • Phone: 425-474-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA70120106
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: