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General NPI Number Information
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NPI Number | 1265628671
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Entity Type | Individual
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Provider Name | CASEY KENYON LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 7465 S 112TH ST
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City | SEATTLE
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State | WA
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Zip | 98178-3102
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Country | US
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Telephone | 206-651-4767
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Fax |
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Provider Business Mailing Address
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Address Line | 532 MEADOW DR SE
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City | NORTH BEND
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State | WA
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Zip | 98045-9419
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Country | US
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Telephone |
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Fax |
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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 | LF00002202
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License Number State | WA
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