Healthcare Provider Details

I. General information

NPI: 1457893877
Provider Name (Legal Business Name): KATIE MARIE EDDY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N MULLEN ST
TACOMA WA
98406-3401
US

IV. Provider business mailing address

2619 N 21ST ST
TACOMA WA
98406-7517
US

V. Phone/Fax

Practice location:
  • Phone: 253-414-4266
  • Fax:
Mailing address:
  • Phone: 253-414-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60714326
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61291771
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: