Provider Demographics
NPI:1083870364
Name:HART, KATIE ROSE (LMHC, CN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ROSE
Last Name:HART
Suffix:
Gender:F
Credentials:LMHC, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 UNION AVE SE STE 105
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1487
Mailing Address - Country:US
Mailing Address - Phone:360-915-2151
Mailing Address - Fax:
Practice Address - Street 1:521 UNION AVE SE STE 105
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1487
Practice Address - Country:US
Practice Address - Phone:360-915-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60138935101YM0800X
WANU60040674133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist