Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | MC 60556138 | WA |
Y | 101YM0800X | Mental Health Counselor | LH60724718 | WA |
N | 101YM0800X | Mental Health Counselor | MC 60556138 | WA |
N | 225X00000X | Occupational Therapist | OT 00003125 | WA |
N | 225XM0800X | Mental Health | OT 00003125 | WA |
NPI | 1871794891 |
---|---|
Provider Name | Tracie Michelle Powney |
First Address | Olympia, WA 98502-4015 |
Second Address | Olympia, WA 98502-4668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 11/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8341315 | (05) | WA |