MEDICARE: MRS. MARTHA S LYTTLE L.M.H.C.

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	LH00005880	WA

General Provider Information

NPI Number	:	1902889496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA S LYTTLE L.M.H.C.

Provider Business Mailing Address
First Line	:	9829 47TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2717
Country	:	US
Telephone Number	:	206-228-9341
Fax Number	:	206-448-4899

Provider Business Practice Location Address
First Line	:	2003 WESTERN AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-2162
Country	:	US
Telephone Number	:	206-860-0155
Fax Number	:	206-448-4899

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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