Healthcare Provider Details

I. General information

NPI: 1902889496
Provider Name (Legal Business Name): MARTHA S LYTTLE L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 WESTERN AVE
SEATTLE WA
98121-2162
US

IV. Provider business mailing address

9829 47TH AVE SW
SEATTLE WA
98136-2717
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-0155
  • Fax: 206-448-4899
Mailing address:
  • Phone: 206-228-9341
  • Fax: 206-448-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005880
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: