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General NPI Number Information
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NPI Number | 1164799854
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE TYRRELL M.S., M.F.T
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Gender | Female
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 1245 10TH AVE E ST MARK'S COUNSELING SERVICE
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City | SEATTLE
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State | WA
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Zip | 98102-4398
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Country | US
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Telephone | 206-323-0339
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Fax | 206-323-0339
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Provider Business Mailing Address
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Address Line | 16843 PALATINE AVE N
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City | SHORELINE
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State | WA
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Zip | 98133-5252
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Country | US
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Telephone | 206-323-0339
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Fax | 206-323-4018
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00001340
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT10077
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License Number State | AZ
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