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General NPI Number Information
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NPI Number | 1023409372
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Entity Type | Organization
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Legal Business Name | KALEIGH PETTIS THERAPY
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 1117 N 85TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-4005
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Country | US
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Telephone | 951-522-0730
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Fax |
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Provider Business Mailing Address
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Address Line | 1117 N 85TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-4005
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Country | US
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Telephone | 951-522-0730
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | KALEIGH PETTIS
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Credential | MS, LMFTA
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Telephone | 951-522-0730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MG 60493139
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License Number State | WA
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