Provider Demographics
NPI:1205006368
Name:MALTBY, MARY MICHELE (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MICHELE
Last Name:MALTBY
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 1:11911 NE 1ST ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3055
Mailing Address - Country:US
Mailing Address - Phone:425-453-7890
Mailing Address - Fax:
Practice Address - Street 1:11911 NE 1ST ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3055
Practice Address - Country:US
Practice Address - Phone:425-453-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health