Provider Demographics
NPI:1164799854
Name:TYRRELL, KATHLEEN MARIE (MS, MFT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16843 PALATINE AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5252
Mailing Address - Country:US
Mailing Address - Phone:206-323-0339
Mailing Address - Fax:206-323-4018
Practice Address - Street 1:1245 10TH AVE E
Practice Address - Street 2:ST MARK'S COUNSELING SERVICE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-4398
Practice Address - Country:US
Practice Address - Phone:206-323-0339
Practice Address - Fax:206-323-0339
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001340106H00000X
AZLMFT10077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist