Healthcare Provider Details

I. General information

NPI: 1902761612
Provider Name (Legal Business Name): DELANEY GRACE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 S MERIDIAN
PUYALLUP WA
98371-7503
US

IV. Provider business mailing address

21318 18TH ST E
LAKE TAPPS WA
98391-9326
US

V. Phone/Fax

Practice location:
  • Phone: 253-948-6497
  • Fax:
Mailing address:
  • Phone: 360-448-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: