Provider Demographics
NPI:1124393475
Name:MARKHAM, MARYBETH (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2809
Mailing Address - Country:US
Mailing Address - Phone:509-795-6437
Mailing Address - Fax:877-795-9797
Practice Address - Street 1:820 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2809
Practice Address - Country:US
Practice Address - Phone:509-795-6437
Practice Address - Fax:877-795-9797
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60558821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health