Healthcare Provider Details

I. General information

NPI: 1417476706
Provider Name (Legal Business Name): HOLLY ELIZABETH BAHNICK LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15214 AURORA AVE N
SHORELINE WA
98133-6143
US

IV. Provider business mailing address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

V. Phone/Fax

Practice location:
  • Phone: 206-518-9021
  • Fax: 206-299-0987
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 NumberLH61033925
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: