Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | MC60222206 | WA |
N | 101YM0800X | Mental Health Counselor | MC60222206 | WA |
N | 101YP1600X | Pastoral Counselor | MC60222206 | WA |
N | 101YP2500X | Professional Counselor | MC60222206 | WA |
NPI | 1245674852 |
---|---|
Provider Name | Kelly Wadsworth |
First Address | Seattle, WA 98116-4553 |
Second Address | Seattle, WA 98116-4553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 25/04/2013 |