Provider Demographics
NPI:1194454538
Name:PROWELL, WENDY CLEARY (LMHCA)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:CLEARY
Last Name:PROWELL
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-6101
Mailing Address - Country:US
Mailing Address - Phone:206-335-6276
Mailing Address - Fax:
Practice Address - Street 1:223 N YAKIMA AVE # 4
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2230
Practice Address - Country:US
Practice Address - Phone:206-335-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61317209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health