Healthcare Provider Details

I. General information

NPI: 1609795475
Provider Name (Legal Business Name): KETRA LEE EMBLETON LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18537 1ST AVE S
NORMANDY PARK WA
98148-1888
US

IV. Provider business mailing address

7815 E SIDE DR NE
TACOMA WA
98422-1142
US

V. Phone/Fax

Practice location:
  • Phone: 425-390-4677
  • Fax: 206-858-9754
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70134833
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: