MEDICARE: MS. CAROL GAY HEARD MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00003412	WA

General Provider Information

NPI Number	:	1073583092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL GAY HEARD MA

Provider Business Mailing Address
First Line	:	12315 101ST CT NE
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-6730
Country	:	US
Telephone Number	:	425-825-7215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 E MADISON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-4752
Country	:	US
Telephone Number	:	206-389-9982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	07/08/2007

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