Provider Demographics
NPI:1235798661
Name:WARE, MARJORY (LH 61184594)
Entity Type:Individual
Prefix:
First Name:MARJORY
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:LH 61184594
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-7519
Mailing Address - Country:US
Mailing Address - Phone:253-237-4383
Mailing Address - Fax:
Practice Address - Street 1:2711 N 21ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7519
Practice Address - Country:US
Practice Address - Phone:253-237-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60882357101YM0800X
WALH61184594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health