Provider Demographics
NPI:1083212922
Name:MECKLE, KATHRYN R (CCC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:MECKLE
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 PACIFIC AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7423
Mailing Address - Country:US
Mailing Address - Phone:253-363-8853
Mailing Address - Fax:
Practice Address - Street 1:19350 GRAND MOUND WAY SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-9218
Practice Address - Country:US
Practice Address - Phone:253-888-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60823258101Y00000X
WACL60868479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor