Healthcare Provider Details

I. General information

NPI: 1568665578
Provider Name (Legal Business Name): TRACY ANN JOHNSON MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 BETTER WAY SE
SNOQUALMIE WA
99065
US

IV. Provider business mailing address

8290 165TH AVE NE
REDMOND WA
98052-3948
US

V. Phone/Fax

Practice location:
  • Phone: 206-724-4116
  • Fax:
Mailing address:
  • Phone: 206-724-4116
  • Fax: 206-724-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH60034726
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60034726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: