Healthcare Provider Details

I. General information

NPI: 1396529301
Provider Name (Legal Business Name): KATIE MICHELLE DAVIS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16225 NE 87TH ST # 160
REDMOND WA
98052-3536
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-2000
  • Fax: 206-901-2010
Mailing address:
  • Phone: 206-901-2000
  • Fax: 206-901-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61330781
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: