MEDICARE: MS. MARY CARTER CREECH LHMC

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	LH00008382	WA

General Provider Information

NPI Number	:	1205023124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CARTER CREECH LHMC

Provider Business Mailing Address
First Line	:	827 32ND AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-3240
Country	:	US
Telephone Number	:	206-409-9355
Fax Number	:	206-325-1218

Provider Business Practice Location Address
First Line	:	1523 E MADISON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4013
Country	:	US
Telephone Number	:	206-409-9355
Fax Number	:	206-325-1218

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

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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