MEDICARE: WHITNEY LAWLESS MFT GRAD STUDENT

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	106H00000X	Marriage & Family Therapist	MFTA.MG.70001880	WA

General Provider Information

NPI Number	:	1861728651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY LAWLESS MFT GRAD STUDENT

Provider Business Mailing Address
First Line	:	3857 MARTIN WAY E
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5268
Country	:	US
Telephone Number	:	360-704-7170
Fax Number	:

Provider Business Practice Location Address
First Line	:	3857 MARTIN WAY E
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5268
Country	:	US
Telephone Number	:	360-704-7170
Fax Number	:

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

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	12/16/2025

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