Healthcare Provider Details

I. General information

NPI: 1073944559
Provider Name (Legal Business Name): CARLA GRACE LMCH, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 11TH AVE NW
SEATTLE WA
98117-3324
US

IV. Provider business mailing address

9055 11TH AVE NW
SEATTLE WA
98117-3324
US

V. Phone/Fax

Practice location:
  • Phone: 206-552-1543
  • Fax:
Mailing address:
  • Phone: 206-552-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60829337
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-5424
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: