Healthcare Provider Details

I. General information

NPI: 1255425104
Provider Name (Legal Business Name): KATRINA MERCER MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 NE 80TH ST SUITE 204
REDMOND WA
98052-3937
US

IV. Provider business mailing address

PO BOX 1530
DUVALL WA
98019-1530
US

V. Phone/Fax

Practice location:
  • Phone: 425-844-0412
  • Fax:
Mailing address:
  • Phone: 425-844-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005504
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: