Provider Demographics
NPI:1164959987
Name:GROOMS, EMILY (MA, LMFTA, CDPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GROOMS
Suffix:
Gender:F
Credentials:MA, LMFTA, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MAIN ST STE 115C
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3166
Mailing Address - Country:US
Mailing Address - Phone:425-616-3009
Mailing Address - Fax:
Practice Address - Street 1:406 MAIN ST STE 115C
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020
Practice Address - Country:US
Practice Address - Phone:425-616-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60778998101YA0400X
WAMG60903057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)