Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY00000756 | WA |
Y | 103T00000X | Psychologist | PY00000756 | WA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY00000756 | WA |
N | 103G00000X | Clinical Psychologist | PY00000756 | WA |
N | 103TC0700X | Clinical Psychologist | PY00000756 | WA |
N | 103TH0004X | Health Psychologist | PY00000756 | WA |
N | 103TH0100X | Health Service | PY00000756 | WA |
N | 103TP2701X | Group Psychotherapist | PY00000756 | WA |
NPI | 1023223419 |
---|---|
Provider Name | Patricia A Marek |
First Address | Bellingham, WA 98225-7065 |
Second Address | Bellingham, WA 98225-7065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 10/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7012479 | (05) | WA |
R31834 | UPN (01) |