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General NPI Number Information
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NPI Number | 1730099268
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Entity Type | Organization
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Legal Business Name | MARY'S LEGACY LLC
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 809 LEGION WAY SE FL 3
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City | OLYMPIA
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State | WA
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Zip | 98501-1518
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Country | US
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Telephone | 425-499-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 809 LEGION WAY SE FL 3
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City | OLYMPIA
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State | WA
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Zip | 98501-1518
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Country | US
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Telephone | 425-499-8822
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Fax |
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Authorized Official
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Title or Position | C PEER SUPPORT SPECIALIST
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Name | MS. TONYA LARRENDA MILLER
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Credential | CPSS
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Telephone | 425-499-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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