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General NPI Number Information
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NPI Number | 1265515951
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Entity Type | Individual
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Provider Name | PHYLLISS MARIE EBERHARDY MS LMFT CCDCI
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11126 SE 256TH STREET SUITE O 204
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City | KENT
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State | WA
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Zip | 98030-5636
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Country | US
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Telephone | 253-852-1586
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Fax | 253-852-7751
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Provider Business Mailing Address
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Address Line | 11126 SE 256TH STREET SUITE O 204
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City | KENT
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State | WA
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Zip | 98030-5636
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Country | US
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Telephone | 253-852-1586
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Fax | 253-852-7751
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CB00006138
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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 | LF00001439
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License Number State | WA
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